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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. N~. 225 <br />~'20 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8;00 A.M. <br /> <br />POLSQN, R,'r CHARD <br /> <br />AURORA <br /> <br />' SlGN^TURE OF APPUCANT ....... ~, ,~, ~' <br /> <br /> ......................... T ~4~ ~OT: ....................................... i C~Y: ,,. ~, ~ ~,, <br /> ~ '~E,~ r D_N,., ~,,.. <br /> ..................... i ¢~$T~ucT~eh ~: ................. ~ ~U.~, <br /> ~ ; <br /> <br /> NE ; .................................................. ~ ....................... <br /> 97002 <br /> <br />............................................ .... <br /> <br />PHONE: <br /> <br /> ON-SITE ~ENAGE <br />~EF~VIIT OR A~RLICATION <br /> <br />CONTF~CTOR, NO, <br />~J~, R~ARD <br /> <br /> 878-2653 <br /> <br /> SITE. NUMBER-' 368? <br /> ' VALUATIC~: <br /> <br />': 32 i 3S i ~N A,q <br />~00 j !2000-0 ~ Sr ~ NO Y~ <br /> <br /> ~TER ~PPLY: <br /> T~T HOL~ <br /> g00~733 SITE ~A~ATI~ NU~ER: <br /> ~iSTING T~K SIZE: <br /> ~ST~NG D~IN FIELD <br /> SEPTIC T~K ~M~D: 2/15/88 <br /> PR~ICUM NO. BEO~: 2 <br /> <br />;o,M ,, uc ~..~; r~v. ~,? OFFICE COPY <br /> <br /> <br />