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MARION COUNTY BUILDING iNSPECTION <br /> SENATOR BLDG. NO, <br /> 220 HIGH :STREET NE <br /> SALEM, OREGON 97;301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588~904 <br /> <br />I am performing work on a pfo~Setty I own or occupy. <br />t am r~ t~gt~4ereQ builder OR ( ) risc au~horized re~resentatlv~ <br /> <br />MA~LING ADDRESS: ~--~ SUBDIVISION: <br /> <br /> .................................................. VALUAT iF)N; <br /> <br />,. .................. ;- $4 ..., .' ................ 8S ...................... 2J¢ ............... -AR:¢. <br /> 0 0; 5. ': AC : NO NO <br /> <br />TYPE: ON-SITE S~NAGE <br /> <br />PEDI~IT OR APPLiCATiON NO.* <br /> <br />CC,~ 'r RAC'f'OR, NO. <br />MEZA, <br />~E <br /> <br />~E: 749-1011 <br /> <br />9039583 <br /> <br />~ATER SUPPLY: PW <br />'F~S'F HOLD.~ READY: <br />S~'~'E EVALUATiF.)N NUMBER; <br />EXISTING 'rANK S~Zg: <br />~JSI'~NG D~IN FIELD <br />~EPTIC T~K ~MPED: ~~~ <br />PRE~i~S NO. BED~: <br /> <br />EXiS1"iN6 SYS'rEt4 EYAL. RPT. . ./ <br /> <br />TOTAL AS~EE~ED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> 1 $]30.00 <br /> <br /> $?30.00 <br /> $o.oo <br /> $!30,00 <br /> <br /> $o_oo <br /> <br /> 4163~ <br /> 55?2 <br /> <br /> PAYEE: ~ZA, LOU RECEIPI' NO: <br /> R~CEiVED BY: mb TYPE: CK ON~CK ~: <br /> SEE A'f"rACHED DOG~EN'r FOR RE(~JiREDI~TS OF ~-SITE S~AGE sYs'r~. <br /> <br />~ THiS J8 NOT A PE~iT. THIS APPLI~T[~ ~ST ~ TH~ A ~I~ P~ ~ERE THE <br />FOLDING ~ST 86 ~PLETED. IT I5 THE R~SIBILITY OF THE APPLI~T TO ~RE THAT <br />ALL NEC~RY iN~T[~ H~ BE~ P~VIDED. <br /> <br />EX/STiNG SYS'f-F_24 EVAL FOR PARTITIONING , <br /> OFFICE CO~ <br /> <br /> <br />