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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. ~'25 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4::30 P.M_. 8:00 A.M. <br /> <br />am e regl~teFed b~ildet OR ( ) the auth.'tied topreaentative <br /> <br />SIGNA~JRE OF APPLICANT: <br /> DATE: <br /> <br />~MITH. EDI~ARD L. <br /> <br />~ILLE ~ 9?325 ! ) <br />vsE o~: 6uic0~~o,. ...................... MARtGN.-q:X3La~T¥ · · .'. -NO ...... <br /> <br />CATEGORY: <br /> <br /> RESI D~NTIAL <br /> <br />C/O R0N SENTZ 133 N.. REGIS ST <br />STAYTCN. OR 97383 <br />iA'NC~E; 769-,6355 <br /> <br />SITE NUMBER; 9152 <br />VAI.J.~T ! CN -. <br /> <br />TYPE: ON-SITE SENA~ <br /> <br />PEI~IT OR APPLICATION NO= <br /> <br />~!~ITN, ~ L. <br />C/O ~ BENTZ 133 N. REGIS ST <br />b-"TAY~N, O~ 97383 <br />PH(~E = ?69-6355 <br /> <br />21116 <br /> <br />HATER ~UPPLY: <br />'I:EST HOLES <br />SITE EVAL/JATION NUNBER; <br />~O T~K SIZE; <br /> <br />~ ~; B~: <br /> <br /> QL~NTITY <br />~ITE EVALUATIC~I, FI~T LDT I <br /> <br />N40UNT <br /> <br /> 175.00 <br /> 175.00 <br /> <br /> $o.00 <br /> <br /> milt OOES I~T 6RAIfr 01t II~Y PEi~ISStm-To'BUlB) liN' THIs' PARCB... PI. AI~INi] <br />C(/b-TIIL'TII;N I~X'l~ I~ I~ 08%t1~ 8ER3~ ItUILDIN~I 0R SBaT/C INSl'ALLATIilhl BBalNS. <br /> <br />REMARF~: ,EE Fat6?10 STD SY~T~ [~ <br />DONALD E. HOODLEY, I~M;IICN COUNTY 8UIL.OIN6 O~FICIAL / Ry ~.:~ <br /> <br />OFFICE COPY <br /> <br /> <br />