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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM. OREGON 97,301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P_M. - 8:00 A,M. <br /> <br /> [ ~m a yegiEtered builder OR ( ) the autho¢ized fel~¢ese~tstive SIGNATURIEi OF APPareNT: ........ <br /> of a ~egiste~ed builder. <br /> <br /> Other <br /> i hev~ee~ an~ Sgree to the terms stated on the reverse s~de of DAT~ ..... <br /> <br />ow~n~ ~RTH. ~TT <br /> <br /> 7767 AL.BUS RD <br />AUr~SV I L L E <br /> <br />SAf4E <br /> <br />PHONE: 74.9-2419 <br /> <br />} TA~ LOT: <br /> <br />' { ~A'R~'~ORY:' CCNHERiCAL <br /> <br />LOT: BLOCK: <br />w~:,: ' .C.~ ~.~; .... <br /> <br />~P6: ON-SITE SEMAGE <br /> <br />PERMIT OR APPLICATION NO= <br /> <br />CONTRACTOR, NO, <br /> <br />SAME <br /> <br />PHONE: 749-2419 <br /> <br /> SITE NUMBER; 2510 <br /> VALUATION <br /> <br /> SECTION: ~ TOWNfSH)P ~ RANGE: ~ ZONE; i MAP~ <br />........... ........... .4 .............. ......... i .................. <br /> <br /> .......................... ~ ............................... t .................................. ,. ...................................................... <br /> <br /> NATER ~JPPLY: <br /> TI~T HOLES READY; <br /> SITE EVALUATION NUMBER= <br /> EXfSTING TANK SIZE: <br /> ED(ISTZN6 BRAIN FIELD LINI!~S.- <br /> SEPTIC TANK PLII~lPED= 9-14-87 <br /> PREVIOUS NO. <br /> <br /> I T~I (~KJANT I TY AMOUNT <br /> AUTHORIZATION NOTICE- FLD. VISIT · ":....... 1 $65.00 <br /> <br />R~RKS: AUk.NOT[CE -FLD VZS[T '" r. .. <br /> <br />D~ALD E. ~OLEY, ~RI~ ~N~ BUILDI~..OFFIC.~AL y BY <br /> <br />OFFICE COPY <br /> <br /> <br />