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UUUNI Y ~UILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HiGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br />The WOES( Will be pedormed by a regisle,ed builder. <br />Other <br />I have res¢l arid agree to the te~ ~teted on fhe .... <br /> <br />07/22/ee <br /> <br />KLEIN,. MIKE <br /> <br /> PHONE 588-5147 <br />CODEoA~PHONE 4:30 P.M. · 8:00 A.M, <br /> <br /> .......... <br /> <br />TZNEf <br /> <br />EESI DENTIAI <br /> <br />515 DRA.KE ST <br />3~ZLVE~TON, OREGON ~73t~1 <br />~5:873-3718 ~ SiTE ~ER= 4977 <br /> .................. = VA~II~ <br /> <br /> ~_~ ~ i ~o+ tN ~ ~ .......~..-.-~ <br /> <br /> 361 89~_ .~ .... ~3~i SF ~.,,, : HO :::,. ....................... .... , <br /> <br />TYPE.· ON-~ITE <br /> <br />PEEMIT OR APPLICATION NO= <br /> <br />CONTRACTOR. NO, <br />KLEIN, NIKE <br />516 OP-AKE ~T <br />31LVERTON, ~OREGON $7351 <br />PHONE: ~73 3718' <br /> <br /> IT8~ <br />STANDARD ON-SITE SY~TE~ <br /> <br />9009903 <br /> <br />HATER ~.JPPLY: J~ <br />TEST HOLES ~Y: <br />SITE EVALUATION NUMBER~ 86-362 <br />EXISTING TANK SIZe, <br />EXISTZN~ DRAIN FIELD LINES: <br />SE. PTIC TANK RJNPED; <br />PEEViOU~ NO. I~EDRO21V~: <br /> <br />PAYEE: KLEIN, MIKE RECEIPT NO: 10587 <br />RECEYVEO BY= cl ~ ~ ; TYPE: CK O4ECK #~ 1023 <br /> <br />PLAN REVIEW: 8Y_~ <br />I;~Ev, Al~t~: PE~4IT ~413S <br /> <br />CITY JURISDICTION~ BY._,__,_.__ DATE ........ <br /> <br /> <br />