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MARION COUhJTY BUILDING INSPECTION <br />SENATOR B'LDG, NO- 225 <br />220 HIGH STREET NE <br /> SALEM: OREGON 97301 <br /> <br /> PHONE: 588-5147 8;00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />OATE <br /> <br /> CONSTRUCTION TYPB <br /> <br /> CONTRAOT OITY <br /> <br />~LARiON COUN FY <br /> <br />21 <br /> <br />D~:ViL*S CREEK SUI~",lSR <br /> <br />9:5, <br /> <br />S ,[ ! E NUI~--~ER '. 1164, b <br />VALUA'f' iON; <br /> <br /> 1g l'C 102 <br /> NO NO <br /> <br />PgP~ir OR APPLI~AflON NO: 9028536 <br /> <br />CrON I~R~'kC[OR, NO. <br />P-O, BOX 421 <br /> <br />WAr~R SUPPLY: PW <br />I B~T HOLES READY~ <br />SiTE EVALUATION NU~V~ER: <br />EXISTING TANK SIZE: <br />8)(iSTiNG DRAIN F~Et.D LINES: <br />SEPTIC TANK PU~PED: <br />PR~rlous NO+ <br /> <br /> '~ TOTAL A,-c.c.c.c.c.c.c.c.%~ED <br /> , ~REV~(,MS REOEIPI~ $0,00 <br /> 'rH~$ RE. CE,[PT <br /> <br /> 8A~CE ~E $0.00 <br /> PAYEE; I~0b.~ifr, K~VtN R~Ei~I NO: 30151 <br /> RECEIVED BY: CL TYPE~ OK CH~CK ~: 288 <br /> <br />* FHi5 18 NOT A PE~IT. THIS AP~i~TI~ ~T ~ TH~ A RE~E~ P~ ~ERE THE <br />~OLL~[NG ~I ~ C~LETED. IT I~ THE R~S[B[Li~Y OP TM~ APPLi~T [0 ~RE [HA~ <br />ALL N~C~A~ iNFO~Ti~ H~ 8E~ <br /> <br />GRAY HALER R.'¢;¢28~ <br /> <br />Cf fY JURi~O,[CTiON; f.'¢Y DATE <br /> <br />OFFICE COPY <br /> <br /> <br />