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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: 588-5147 8:00 - 4:30' <br /> ' 24 HOUR CODE-A~PHONE: 588-7904 <br /> <br />~ em performing wo,'k on a property I own ~r <br />I am a registered buHde~ OR ( ) tho ~uihorized represent~tiv~ ~IGNAYURE OF APPLtCANT ............................... <br />0f a registered budder, . <br />The work will b~ Deformed by a ~egl~terod builder ~ ~ ' ' <br /> <br />~ nave read and agree to the term6 stated 0~ t~ ~eV~me sido of 0ATE .................. <br /> <br /> AU~ OR 9?002 <br />'5~-6~.~ ............................ ~ .......... ~ --~O .......... ~ h~"~'~o~oo~s-- <br /> <br />!W-I~YH ~)~: PTH <br /> <br /> SiI"P~ NUtC3ER; , ~o14 <br /> ..... -.~,..!l.~,~3'~(,.~L~,~ . ..... ~ ....... ' .'-"_t _::~- ._ <br /> <br />.... J ~,S ' <br /> <br /> ........... NO. J _ NO .. <br /> <br /> FYPE: ON-~I'[E <br /> <br />PE~'41F OR APPLICATION NO: <br /> <br />CON FRAC'roR, NO. <br />BLATCHFORD, DON <br /> <br />9034932 <br /> <br />WA[ER 6AJPPLY: ~ <br />T~T HOLES READY: <br />SII~ ~VALU~"F~ON NU~ER: <br />~3(ISFiNG TANK SIZE: <br />ETXI~FiNG D~IN FIELD LiNE~: <br />~PTIC T~K ~PED: 2-15-88 <br />PR~I~S NO. D~O~; <br /> <br />EXiS¥1NG ~YSTEN gVAL. RPT. <br /> <br />(~XJANIITY Ah'IOUN~ <br /> 1 $100,00 <br /> <br /> TOTAL A.S~5.SED FEP-..~ $300_ 0(J <br /> PREVIOUS R~CEIPT$ $0,00 <br /> - THi3-~CEIPT $100_0U <br /> ~C~ ~E $0. O0 <br />PAYEE: 8~T~FORD, ~ ,INVOICE NQ: 36821 <br />RECEIVED 6Y~ cl ........................... ~ ....., rYPE~ IN ~ECK ~; O <br />5~E ATTA~ED ~N~"~' FOR R~[~T~ O~S-[~E 8~E SY~T~. <br /> <br /> NOT _A_P~LSi~Ii'I'. THIS,:'AI:~PlLI'Cil~j',~_ I~US?,~60 ~I-t~A REV~ PR0C~;~--'"FJ~-~ ......... <br /> f,~JST UF C;~I'qPLETED. :~-T .1tS THE~'~ISJ[L~TY OF THE APPLICANT TO AF,.camlT¢' THAT <br />NI~=~ARY INFO~C~TIOq HAS ,8~ PRO~[!~'ID..;z .............. <br /> <br /> <br />