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MARION COUNTY BUILDING iNSPECTiON <br />SI~NATOR BLDG. NO 2:25 <br />220 HIGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE; 5~-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br />~] FILL[ ,c'X)~F N. ~'ANIiAJ"4 HWY <br /> <br /> CO NTR,~.CT CITY <br />~nAR ~.ON COUNTY <br /> <br />NO <br /> <br />R~IOR~,, FICNER~EY, JER~Y <br /> <br /> / <br />tYPE; ON-~i1E SEWAOb / <br />P~R~[ I OR. APPL.[(;AI.[ON NO: <br /> <br />~OR, NO. <br /><SFAT~ OF O~ H~ <br /> <br />P-O. 1583 DE1ROll, OR <br />PHONb; 864-3809 <br /> <br />~0 <br /> <br />WATER E~JPPLY: gW <br />IP~I HOLI:;~ READY: <br />~I1E b~A~ArI~ NU~ER: <br /> <br />~i~TIN~ D~IN FIELD LiN~: <br /> PIiC l~K ~MP~O; N~D lO CALL <br /> <br />MAP <br /> <br /> ilar4 <br />AUIHORIZAI i0N NOF~CE - <br /> <br />PAYEE; r4(JNE <br /> <br />VI3I F <br /> <br />QUANtiTY <br /> ~ $]05.00 <br /> <br />TOTAL ~E~EO FEES $1o5.oo <br />PREVIOUS R~CEIPTS <br />THiS RECeiPt ~ . . /]. .~ ~ $]05.00 <br /> <br /> '/~t~'g~E: OK C~ECK 430~ <br /> <br />FOR RE.~IiJ~R~,~J~T5 OF ON-5ITE ~ENAGE SY~TEM~ <br /> <br /> ~ THZG £~ btOTA P[F~iT+ THI~ APPLICATION ~'Lk~T GO TH~3UG[-t A Rb-VIE4 PRO3~,S,5 THE <br /> FOLL0~ZN~ Dll. JST B~COt¢PLETEO. IT I$ THE BE,!~gOONSZBILITY OF THE APPLiCaNt TO ~ THAT <br /> , ALL NEC~,ARY INFOI;~TIC~N HA.~ BEEN PROVi OEO. <br /> <br />/ <br /> <br />~o~ ~ MC ~ ~,EV ~0 OFFICE COPY <br /> <br /> <br />