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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-514'/' 8:00 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> QON~TRt)C¥1ON TYPE 40921-000 <br /> <br />NE <br /> <br /> F'IA R .t ON COUN l Y NO <br /> <br />97002 <br /> <br />LOT <br /> <br />BLOCK <br /> <br />~AN~ALUA,J-iC~: ZONE <br /> <br />22 UN~T~ <br /> <br />4,~ IW <br /> NO '~NO <br /> <br />5 <br /> <br />PERf4IT OR APPLiCATiON NO: <br /> <br />L,Z.,INf'~ACIOR, NO. OEQ 33458 <br />J1N HICKS EXCAVAtiNG <br />P.O- BOX 597 <br />CANBY, OR 9701~ <br />PHONb: 266-5975 <br /> <br />REPAIR - ¢4AJOR <br /> <br />9027318 <br /> <br />~A'FERSUPRLY~ PN <br />TEST HOLES READY: <br />~ITE ~¥ALUAIiON NUFg,~R; <br />~X~STING TANK,SiZE: <br />E.,h<ISTiNG DRAIN FIELD LiNfz~S: <br />SERLIO lANK Pu~PED: <br />P~EViO~S NO~ MEDROOtv~: <br /> <br />QUANT I fY A.~OUN I <br /> <br />TOIAb AZ~SESSED FEES <br />THZS RECEIPT <br /> <br />~ALANCE <br /> <br />PAYEE: WILDER. SANUgL R6OgIP; NO: <br />R~C~IVED BY: CL <TYPE: CK C~SCK ~: <br /> <br />5E~ AI'FACBgD DOr~U~E~T FOR RE(~RE~ENT~ OF ON-81TE ~EWA~ ~YSTEJ~+ <br /> <br /> $0.00 <br /> $80.00 <br /> <br /> $0,00 <br />28908 <br /> <br />2429 <br /> <br />* THIS 15 NOT A PEf~[T. THIS APPLICATION IVUST GO THF~OUGH A REVIEt*J PROCE~ V/,flE/~E THE <br />EOLLOI~JING IW~ST BE C~FIPLETED. IT ~$ THE RE~I~ILITY OF THE APPLICANT TO A,..%SURE THAT <br />ALL N~Y iNPO~TION HA~EEN PF~CIDED. <br /> <br />REFbARK5,: fAAJOR ~6PAiR R~4079 <br /> <br />JUR~SD;CriON: 8Y <br /> <br />OFFICE COPY <br /> <br /> <br />