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MARION COUNTY ~UILDING INSPECTION <br />SENATOR BLDG. NO,~25 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-,5147 8:00 - 4:80 <br />24 HOUR CODE*A-PHONE; 888-7904 <br /> <br /> I am a registered buil~ter OR ( ) the authorized reD~esentative <br /> <br /> The work will be pedormed by a ~egiatered builder, <br /> <br />~'I'E = 08/01/91 <br /> <br />100 GUY~OR~ DRIVE <br />D~'~" ROI T OR <br /> <br />~-~ONE: NC~E <br /> <br />LOT: <br /> <br />WIDTH: <br /> <br />5 <br /> <br />· BLOC~ ; SECTION: <br /> 13 1 <br /> <br />Ivp~: ON-~i'I'E <br /> <br />P6RMi'[' OR APPLICATIC~ NO: <br /> <br />CONTRACTOR, NO, <br />KiNG~ <br /> <br />P~C~NE: N~E <br /> <br />3 <br /> <br />~¢~OKEY CREtE~ ............ <br /> <br />SiTE NUt'ER ,, I'32 <br /> VALUA'I* J ON = <br /> <br />: NO ; NO <br /> ........... !"=[7"? ...... ~ ............. <br /> <br />HAT[R SLJPP~Y: <br />TE~'F HOLES READY: <br />~ITE EVALUAT~0N NUIV~ER: <br />EXISTING TANK SIZE: 750 <br />I~ISTING DRAIN EiELD LINE~: <br />~EPTIC TANK <br />PREVIOUS NO. <br /> <br />REPAIR - NAJOR <br /> TOTAL A~I~E, ED. FEm' <br /> PREVIOUS RECEIPT8 <br /> THiS 'RECEIPT <br /> <br /> BA~CE <br /> <br />PAYEE~ K]N~, J~ .: <br />R~CEiVEO ~Y: CE ' ~ECK <br /> <br /> Alv,LTJ N I <br /> $80.00 <br /> <br /> $8o,oo <br /> $80.00 <br /> $~J,O0 <br /> <br />36038 <br /> 0 <br /> <br />* THIS IS NOT A PE~IT. '. THiS APPL/CATION JYiU~T GO THROU~H A REVIE~ ~ I/~HERE THE <br />EOLLON[NG ~l.~T BE CONPLET~. I~ i~'.THE "RE~I;~N~iBILI'~ OF THE APPLiC~NT TO A~.e.e.e.e.e.e.e.e.e~URE THAT <br />ALL NEC'~;.~ .[NFOi;~t~TiON HA~ B~I~I. PR~/IDE, D, <br /> <br />PLAN RS¥IEW: BY__,~,.I(= ........ DATE ............. <br />REMARKS: r,~JOR REPAIR <br /> <br />CiTY JURiSDiCTiON: ~Y ............... DATE ........................... <br /> <br />OFFICE COPY <br /> <br /> <br />