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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLOG, NO. 225 <br />2.20 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />PHONE; 588-5t 47 8:00 - 4:30 <br />HOUR CODE-A-PHONE: 588-7904 <br /> <br />~ t~m ~ registered builder OR ( ) the authorized repreger~tative <br />The work will be ~efformed by ~ regi3temd builder. <br />I Mere read and agree to the ter~S stated on ~he reveme side~ <br /> <br /> ~. ~ LC-,. ~[?e ................ T~H~. +~,__> .~.~I:. <br /> <br /> STR;~N6ER~ JZH & H~NNELORE <br /> <br /> ~.~0 ,~ANTIAM ~V <br /> DI~';TRO T T OP. <br /> <br />i~^u_~ ×~,~: ...................................... <br /> <br />SIGNATURE 0¢ APPLICANT: ....................................... <br /> <br /> J R~,~IDEN~IA. <br />~ CONSTRUCTION ~PE; j OCCUPANCY: <br /> <br />: DETR'O~T ' <br /> <br /> 2 <br /> <br /> HAMMOND ADeN <br /> <br /> SiTE NUHBER~ <br /> VALUATION: ; <br /> <br />TYPE= OH-SITE SEWA~E <br /> <br />PERMIT OR APPLICATION <br /> <br />CONTRACTOR~ <br />STRIN~ER~ iI~ & HANMEL, ORE <br />S091DEE~I~G'AV NW <br />SALEM. OR 97S04 <br />F'HON~ ~64'-1~I7 <br /> <br />475~e <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: <br />S.iTE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 750 <br />ExiSTIN(; DRAIN FIELD LINES: <br />SEPTI~ ,~ANK PUMPED: ,8.,-18-92 <br />PREVIOUS NO. I~EDROOMS: <br /> <br /> ITEM QUANT:[TY AMOUHT <br />AUTHOR:[ZATiON NOTICE - FLD'~ VISIT 1 $~'~'.~'~.~ <br /> <br /> TOTAL ASSESSE9 F[E~ <br /> PREVIOUS RECEIPTS <br /> ,,' THIS RECEtP. T.- <br /> .'~f_~NCE DU~ ~. <br /> ~ ~' ' "' ~ INVOICE <br /> F AYEE,, :":" "'"' ..... <br /> REC~]~VE~ BY: CL , · TYPE: CHECK ~: 0 <br /> S[~J ATTACHED DOCUMENT FOE' E~QUIREMENTS OF Q~.-~iTE SEWAGE .SYSr~,~." <br /> ~ THIS IS A VALID PERMIT ~ THIS PERMIT EXPIRES ~6~ DAYS FROH ITS ISSUE ~ATE. IF <br />CONSTRUCT~N FAT. L.~ TO MEET ALL ,~UI,~EHEN~S OF'STATE LAWS AMD MARION COUN'Y ~U~I..DiMG AND <br />~..O~j. ~C ORDINANCES, ThL.~ PERMIT SWA.L ~.,.,Q.,E N~[_L AND. <br /> <br />E'ENARKS: AUTH <br /> <br />DO],iA~.D E,, I;,;[)ODi:.,,EY~ <br /> <br />FORM # MC 15.~ RI'V, ~J~O OFFICE COPY <br /> <br /> <br />