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MARION COUNTY BUILDING INSPECTION <br />SI:::NATOR BLDG, NO, 225 <br />2~'0 HIGH STREET NE <br /> SALEM, OREGON 97'301 <br /> <br /> PHONE: ,588-5147 8:00 - 4:30 <br />24. HOUR CODE-A-PHONE: 588-7904 <br /> <br />have re~,d ~,nd ,3,~ree t~ the (~rms s(~,'~ed ~,~ [he';'eve~¢ Side ~f DAT~: ........................................ <br /> <br /> T ?,~ ~;~= ~ .............................................. ~:. ......... <br />- ~j]~;~- ........... 3Ax <br /> <br />~)GNATURi~ OF APPUJ~ANT; ......................................... <br /> <br />PERMIT OR APPLICATION <br /> <br />47297 <br /> <br />;~ATER SUPPLY: PW <br />T,~T HDLE~ REA~ <br />SITE ?ALUATZON NUMBER: <br />EXiST,lNG TANK SIZE: <br /> <br />SEPTIC TANK PUdPED: <br />F'REV,,gU; NO. 8~:DROOMS~ <br /> <br /> TOTAL ASSESSED FEES <br /> ~R~¥tDIJS R~CE1PTS <br /> .' fills R~CE~PT' <br /> <br /> BALANCE DUE <br /> P~'.ly~: . ' ' .', · " ,~E~ZF <br /> RECEIVED BY: .~ , TYPE: <br /> <br /> SEE A'~-TACHE5 ~)OCUfi~;NT FOR ~E~t;IEEMENTS .... OF'ON-S~TE' ' SEWAGE <br /> ~ 7HI~,.iS A VALID PERfl~T ~ T~IS P~R~IT EXPIRES 36B DA~S FROM ZT~ i~SUE DATE~, IF <br />C]N~TF:U~ ~gN FAILS TO MEET ALk REQ[JZRE~ENT9 OF .STATE LAW5 AND MAI~iDN COLNTY <br />ZON][NG ORDJ.'NANCES~ THIS PERMIT S~ALL B~CO~E HULL' AND <br /> <br />:';ONAL. I) S;, <br /> <br />A~.~ .,-~A ~0.., IN~TALL_,,x .~.A= AND F.'EF1 <br /> <br /> !,iOOf)!.EY~ MA~ cN hu.~!~¢l Bdi~..,~IN~;. ...................................................................... <br /> <br />OFFICE COPY <br /> <br /> <br />