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MARION COUNTY BUILDING INSPECTION <br />E~ENATOR BLDG. NO. 225 <br />220 HIGH :STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE; 568.5147 8;00 - 4:80 <br />24 HOUR CODE-A-PHONE: 568-7g04 <br /> <br />APPLICANT <br /> DATE <br /> <br /> JCHNE~N, EARL <br />SITUS ADDRESS <br /> <br />CONSTRUCTION TYP~ <br /> <br /> 8?54 ~IlLL CREEK RO <br />AUt~V[ LLE. OREGON <br /> <br />OR 97325 <br /> <br />~UPA~T ~.~ <br /> <br />2 <br /> <br />PHONE: ?4g-2E01 <br /> <br />SiTE NUMBER: 4~'7,~ <br /> VALJJAT iON: <br /> <br /> N~ NO <br /> <br />WATER ,E~JPPLY: <br />TE.,ST HOLE~ I~..ADY. <br />SITE[ EVALUATION NUIVBER; <br />EX.[STING T~K SIZE~ <br />~[~TING D~iN PiE~ L~NES: <br />SEPTIC T~K <br />PR~I~5 NO. 8ED~: <br /> <br />ANNUAL .~'~'AL. - FENP OR HC~'~-IP ~ <br /> <br />PAYEE: <br />RECEIVE[D BY: CL <br /> <br />TOTAL AEx~ES~ED FEE~ <br />PREV[OU~ Ri~CEI PT~ <br />THiS RECE [ PT <br /> <br /> .. ..................... tYPE: CHECK <br /> ~EE ArIACHED DOCUMENT FOR RE(~JIRE~ENT~ OF ~ITE S~GE 3~T~, <br /> <br />~I~ ~1~, THI~ ~IT ~ 8~5 ~ ~O VOlO. <br /> <br />REMARK,S: ANNUAL HARD,SHiP RENEqHAL. P2~56~ <br /> <br />~ALD ~;. HOODLEY, J'~Rlr,,,~ C,tOUN1Y BUILDING OFFICIAL <br /> <br />OFFICE COPY <br /> <br /> <br />