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MARION COUNTY BUILDING INSPECTION <br />SENATOR I'"-ILDG,, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 87301 <br /> <br /> PHONE: 588~5t 47 8:00 - 4;30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> ~rn performing work 0fl ~ Dt0DtrtY I Own or ocoupy <br />I am a registered builder OR ( ) the authorized representa{ ve <br /> <br />OWN~IE: 02/05/92 TiM[i; ' ' ~ <br /> 5NODD~RLY, lit403HY <br /> <br />AURORA OR 97002 <br /> <br />DATE:: <br /> <br />TAX "LOY' <br /> <br />OCCu~^Nc, Y <br /> <br />15051 PARK AVE <br />ADRORA, OR <br />PHONE; 6'78-2285 <br /> <br />[;ONT~C¥ C~, u <br /> <br />~ 39 ~ ?'_2: 23908. <br /> <br />PER~I~ OR APPLiCATiON NO: 38184 <br /> <br />CON TRAC FOR, NO_ <br />,5~NODDERLY, 'T[~rHY <br />~5051 PARK AVE <br /> <br />PHONE: 678-2285 <br /> <br />TEar HOLE"~,5 R~.ADY: <br />SI1E ~WALUATION NUIV~ER: <br />EXISTING 'TANK $1ZE: <br />E)<iSTING ORAIN FIELD <br />:SEPTIC T.a.~K PUMPED: <br />PREViOUs NO. BEDF~Ct,~: <br /> <br /> ~ l"P_i'q C~JAN r i TY <br />5~- < 6 MONTH~ OLO 1 <br /> <br /> FOTAL AEx.~E.~ED <br />PREV I F.,~.t5 RECEI P3.~ <br />THI~5 RECEIPt <br /> <br />BALANCE <br /> <br />$1~5.00 <br />$~15,00 <br /> $0.00 <br /> <br /> $0,00 <br /> <br /> RECglVEO BY: mi TYPE: CHECK ~ U <br /> <br /> ~ AT~ACHED L'~M~,IT ~OR REF.~JIREMEN'F5 OF ON-~[FE $~,GE 5YSTEN. <br /> .................... ........ ............ <br /> ~ THIS I~ A VALID ~IT ~ THIB PE~iT ~Pli~ 360 DAY~ 'F~ ~TE. iF <br />~T~CT]~ EAi~ TO NEET ALL ~IR~T~ OF ~TATE ~ ~D ~RI~ ~NTY BUJLDJ~ ~D <br /> <br />REMARKS: STI) ~YSTEM ~ ~ <br />I;×D~ALO ~. WOODL, EY, NARiON COUNIY 8LIiLDiNG OP'FiCIAL / BY ........................ ~ <br /> <br />OFFICE COPY <br /> <br /> <br />