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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDGJ NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGOIN 97301 <br /> <br /> PHONE; 588.514-? <br /> 24 HOUR CODE-A~PF <br /> <br />I am performing work on a property I owh or occupy. ' <br /> <br />The work will be performed by a registered builder, <br />Other <br />I hove read and aBree to the terms stated on the reveille side of <br /> <br /> 8:00 - 4:~0 <br />ONE: S88-7904 <br /> <br /> S~GNATURE OF APPLICANT: <br /> DATE'. <br /> <br /> ~ CONSTRUCT ON TYPE: <br /> <br /> CONTRACT OiTY'. U~; ~A~'? ~O~D'. <br /> I ~6,-,..~ EI"H,,.EN R~ ..... ~;N'E, <br /> NO <br /> <br />....... ~ 4 <br /> <br /> S~TE NBN~ER~ 94-~342~" <br />PHONE~ ~ VAI._UATION= <br /> <br />57832 <br /> <br />WATER SUPPLY: <br />TEST HOLES REA;DY: <br />SITE EVAL. L~ATION I,IIIM~ER: 14066 <br />EXISIlNG; TANK SIZE: <br />EXISTING DRAIN FtBLD LIKES: <br />SEPTIC TANK PUfF'ED: <br /> <br />TYPE= ON-SiTE <br /> <br />PERMIT OR APPLICATION NO-' <br /> <br />.,0NIRACTOR., ~fJ. 36499 <br />F' "URI: 9 :fN; <br /> <br />'l UAL. ATIN~ <br /> <br />'.,. )AR( ON-SIrE SYSTI!;M,: <br /> <br />PAYEE: <br /> <br /> THiS [SA VALI~ <br />CONSTRUOTION F'AIL. S TO <br /> <br />' INVOICE NO: <br />!::: TYPE: CHEC& 4[: 0 <br /> <br />~YSTEM,, <br /> <br /> ITS ISSUE BATE. IF <br /> MARI0J,! COUNI"Y };~i.J:[I...DTi.,~,'.-, A?, <br /> <br />Y)OHA!.;!) E,, WOOiOLEY,~ N'ARIO:N'COUNTY BIJZ~i':f)I <br /> <br />FORM # MC 15.58 R~v', 4/90 <br /> <br /> <br />