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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />2~'0 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> .PHON'~ 58B'-5147 <br /> CODE-A-PHONE 4:30 PiM. - 8;00. A~M, ~ "./ <br /> registered t, uil(:ler. <br /> <br />here re~ end agt~ to ~he terms ~t~t~ On the reverse s~e ~ ~TE: ....................... <br /> <br /> ~OX, MI~AEL ~ <br /> <br /> OR. <br /> 97325 <br /> <br /> 76~72~g ,' ~ITE NU~ER: <br /> <br /> 249 474 : 118026. ~F NO ~ NO <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PERN~T OR APPL[CATZON NO: 900533g <br /> <br />CONTRACTOR, NO. 33606 <br /> <br />PO BOX 869 <br />M~AJ~ OR 97384 <br />PHONE: 394-344? <br /> <br />HATER ~JPPLY: PW <br />TE;~T. HOLE~ READY: <br />SITE ~A~ATI~ NU~ER= 12-76-27 <br />~ISTI~ T~K <br />~ISTING D~IN FIE~ L~N~: <br />~EPTIC T~K <br />PR~I~S NO. BE~: 0 <br /> <br /> QUANTITY <br />STANDARD ON-SITE SY~TEN '. ,,, 1 <br /> <br />$125.00 <br /> <br />$125,00 <br /> <br />PLAN REVIEW: BY DATE . .'CITY JURISQ[CTION= BY <br />REMARKS: STANDARD SYSTEH ~8068 " ':': <br /> ! <br /> <br />DATE <br /> <br />~,o,,,~, .,. ,~ ,~ .s~ .tsv, e,/s';, OFFICE COPY <br /> <br /> <br />