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MARION COUNTY BUILDING INSPECTION <br />SENATQ~R BLDg. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON c~T$01 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 58~-7904 <br /> <br />I am ~edorming work on a property I OWt~ 0¢ occupy. <br />I ~,m ~ registered t),Jilder OR ( ) the ~uthorized rel~resenla4iv6- <br /> <br />E4GNATURE OF APP'- CANT~ ...... <br /> <br /> DATE: ........... <br /> <br /> OVE~, RICHARD & ~iRL~ 56501-909 <br /> <br />~SV i LLE OR 97325 : , <br /> <br />RESIO'*----------------mN <br /> <br />PHONE ~ 769~4079 <br /> <br /> SITE NUf"~ER: <br /> VALUAT I ON: <br /> <br />261 260 67860. ' SF : NO; NO <br /> <br />TYPE: ON-SITE SEWA6E <br /> <br />PERFL[T OR APPLICATION <br /> <br />SA~E <br /> <br />~E: 769-~079 <br /> <br />39~27 <br /> <br />WATER SUPPLY: PW <br />'r~'r HOLES RE, ADY: <br />SiTE EVALUATION NU,V~BER: <br />EXISTING T~ <br />~ISTiN~ O~IN FiELO LINE~: <br />~EP'r~c T~K <br /> <br /> iTE~ <br />REPAIR - MINOR <br /> <br />PAYEE: <br />RECEIVED BY: CL <br /> <br />SEE AT'f'ACHED DOG%INEI4T FOR RE~/,JIRE~P-...NT5 OF Chi-SiTE SEWAGE <br /> <br /> 6XJANTiTY A,'vlOUNI <br /> $?O_O0 <br /> <br />TOTAL AE~ED E~E$ $70.00 <br />PR~/ZOU~ .RECEIPTS $70.g0 <br />THI~ RECEIPT $0.00 <br /> <br />~ALANCE CUE $0.00 <br /> <br /> RECEIPT NO: <br /> CHECK ~ <br /> <br />* THIS i$ A VALID P~ZT * THi~ PEF~VlIT EXP~RES 360 OAYS. F'RO~ iTS I,~,SUE DATE. <br />CONSTRUCT,ON FA[L~ TO NEET ALL R~piE~X,I~L%E~(~ OF STATE ~ AND NARIC~I COUNTY 8U,LDiN6 <br />ZONING ORDINANCES, TH[~ PEI;~T NULL AND VOID, <br /> <br />R'Eh'i~RKS: ~EP'TIC TANK REPAIR ~ <br />CONALO E. WCODLEY, ~RiON COXJNTY BUILDING OFFICIAL / 8Y .............................................~ <br /> <br />ro~ ,~ ~,c ~s-~ RE~. ,~ OFFICE COPY <br /> <br /> <br />