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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HI(~H STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 5B8-5147 8:00- 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />i am performing work 0¢i a property I own or ~¢¢upy, <br /> <br />Other <br /> <br />'dw.l~l~A"FE': ' 05/12/92 ........ =f:fl~..t ' ')5 :'58-.-'1zl, ................... :-¥Xx'Lbt: ..................... <br /> <br /> O~E~., RICHARD ;& ~!i4,1,~EL.E:Y ......... : ............ 5~5.0..:-9Q9.. <br />· $1TU~ ADDRESS! ; CON~TRUC¥10N YYPE: <br /> <br />11937 CAU.~"'Y J.J~ ~. ; CON¥1~AOT CITY; UGS! <br />AUMSVi LLE OR 9?325 : <br />use' b¢'~U~d~b,. ......................................... ~I~'](QN ~NT~ ........... NO" <br /> <br />'TYPE: ON-SiTE .~8"NAGE <br /> <br />PERt, lIT OR APPLICATION <br /> <br />CON'f RAC'i"OR. NO. <br />OVER"EON. RICHARD & E~HIRLEY <br />SANE <br /> <br />pHONE; <br /> <br />REPAIR -- ~IiNOR <br /> <br /> WAI'ER .~,~PPLY= F~ <br /> TE~T HOLE~ READY: <br />,9039927 siTE EVALUATION NU~ER: <br /> ~IST ING T~K <br /> ~JSTING D~ZN FIELD <br /> S~TIC T~K <br /> PRiZeS NO. BED~: <br /> <br /> ,~ .~ ............ <br /> <br /> TOTAL ~ED FEE~. <br /> 'PR~I~ ~EIPI'~ <br /> 'FHI~ RECEIPT <br /> <br />~AI,~uNCE DUE <br /> <br /> At~UNT <br /> <br /> $7o.00 <br /> $0,00 <br /> $7o.oo <br /> <br /> $0.00 <br /> <br />419~8 <br /> 399 <br /> <br /> PAYEE.: OVE~;CN, RICHARO ~ ,~IRLEY RECEIPT NO: <br /> RECEIVED BY: P'~ ~,-----,-t-;-7.~-'--~:~r--,.:,;:-_-_--.--'-, <br /> <br /> GEE ATTAC~ED LT, DOJMFDN'F FOR REQUiRE~I~T~50~, ON*"~ITE <br /> <br />~ THi~ IS NOT A PERf4IT. THIS APPLICATION /vL~T ~0 THROUGH A REVIE~ PRO~ I~HER~ THE <br />FOLLOWIN~ /~T B~ COMPLETED. IT I,~ THE RE~:~N~IBILITY O~ TH~ APPL. IC~NT TO A,.~RE THAT <br />ALL NEC~LY~ARY [NFOR~ATIQN HA~ r~Ee~ F~iDEO, · <br /> <br />PLAN R~ViE~.. ~BY, , A'tE.L~" CITY JURISDIC'~ION; DY ............... <br />R~ARK$.* ~EP'1'IC TANK PJ~PAIR <br /> <br />OFFICE COPY <br /> <br /> <br />