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MARION COUNTY <br /> DEPT. OF BUILDING iNSPECTION <br /> Sector Buildi~j # 225 <br />App~ _evd~~ ~ 2~0 High St., N.E. 2nd FIoorsalem, O~n g7~1 <br /> R,H. ~R~, BL~. ADMINISTRATOR <br />5: B~147 - ~-51~ <br />Date.. ~ ~ /~ ~ ~ ...... . P,M,-- ....... CODE-A-Phone 58&~73 ........... 8:00 <br /> <br />TV~ of P~it; ~ ~ax Lot <br /> <br />Permit NO,, <br /> <br /> Roof <br />Basement; ~ Type: , , <br />Heating <br /> <br />I~TU; ..... <br /> <br />Rge. <br /> <br /> ZONING SEPTIC TANK <br /> By: By: <br /> <br /> I agree to bu#d acCOrd/nD to the ~bm/t~ed pJall$ ~ ~ec./f/cat/ons, O~e laws of ~ha State of Oregon and ~ha Or/dnancezofMarion <br /> C~ty. Perml~ expires ff ~rk not ~mme~ W~I~ 1~ day~ I fu~ exper warrant ~at I C~iy w~h ~he p~vlsions of ORS <br /> 701.~ ~0 701,128 ~: <br /> <br /> ~ ) The ~ ~111 ~ pe~ by ~ ~i;=~ builder <br />~ I am ~mi~ ~ on a ~ I o~ or ~upy <br /> <br /> R~MA~S: ............ <br /> <br />valuation: <br /> <br />Stats S~a~e: <br /> <br />PI~s Chk. Fee: <br /> <br />Total <br /> <br />I have teed this application in /t~ entirety and certify t~a;~ ~he Stated in~rmadon [~ ~ue ~d co~t ~ ~e ~ of my k~w/~e. <br /> <br />SIGNATURE OF APPLICANT'~ ~ ~~ ~-- ~~ <br />PLEBE ~TE: Driveway a~ sid~alk ins~ons a~ r~ulr~ by Public Works: ~36 <br />Oth~ ~mits r~ulr~ by th~ de~: Plumbing ~ El~tri~l ~ <br /> <br /> <br />