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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HiGH STREET NE <br /> SALEM, OREGON g7301 <br /> <br /> '~' PHONE 588-,~147 <br /> CODE-A-PHONE 4:30 P.M. - B:00 A.M. <br /> <br />The werk will ~ ~dormed ~y s registered builder, <br /> have read and'agree to th~'~erms stated on {he reverse s~de of <br /> <br />SIGNATURE OF AF~0MCAN¥: .................. <br /> <br /> DATE; .............................. <br /> <br />RE~ DJ~TI AL <br /> <br />TYPE= QN-S:[TE <br /> <br />PF, RffilT OR APPLICATIC~t <br /> <br />CQA~, EOi:~EY & MARIA <br />PHONE: 581-1872 <br /> <br />12203 <br /> <br />NATEESUPPLY= PN <br />TEE[THOLES I~EADY: <br />SITE EVALUATIC~I~ER, <br />EXISTING TANK SZZE= <br />EXISTIN~ DP. AIN FIELD LINES: <br />,~-PTIC TANg PLeiaD: 4-1-$8 <br />PREV~0USNO. 8EDR00MS= <br /> <br /> AUTHO~IZATi~CN NOTIC~ ~ FL,.O. VISIT .::'<, ,'" , 1 $105.00 <br /> ~'~~ $~o5. oo <br /> · ' ',',, ~.'.. ,.:~,.~.~m' $ ~ os. oo <br /> O0 <br /> <br /> "L'.:? ,? ' "~:t"' '~:~,'~ .~E ~, '. $0. O0 <br />~" PAY~ ',',., ~. ~m~'~,, .." '; ,, ~ .-,' '~l~,~ <br /> <br />IOONALO E. ~LE'Y, NiARION COUNTY BUILD~'"~'FICiAL / <br /> <br />OFFICE COPY <br /> <br /> <br />