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DEPT. OF BUILDING INSPECTION <br /> HC~IDAY ~,enator Building # ~ <br /> , 2~ High St.. N.E. ~d Flor P~mi~ NO. ~4-~205 <br /> <br /> Ty~ of Permit: ............ , , T~ Lo~ No: <br /> <br /> B~g. <br /> <br /> Sep~c T~ <br /> Exi~L No. <br /> <br /> ~e: ....... ~ . P~mit Fee- <br /> <br /> p,Ov~, oF ORS TOTAL FEE, , <br />~ ] J am ~rm, RECEI~ NO,~ <br /> <br />REMARKS: _ <br /> <br />/ ~ r~d th/~ ~ in.treat~on is ~ue ~d corr~t to ~e ~t of ~y k~wt~ge. <br /> <br />~IGNATURE OF b <br />P , ~v~ay a~ s~alk ~m~ions are r~uir~-by Public Works: ~.~ <br /> Other ~rmlts r~uir~ by this de~: Plumbi~ ~ Electrical <br /> <br /> <br />