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MARION COUNTY BUILDING tNSPEC¥10N
<br />SENATOR BLDG. NO. 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> PHONE: 5~-5147 8:~ ~ 4:80
<br />24 HOUR CODE-A-PHONE: 5~-7~
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<br />of a reg stered bu der.
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<br />Other.
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<br />SIGNATURE OF APPLIOANT; .................................................
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<br /> OATE: ............ ..............................
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<br />APPLICANT: JOHN CHECKAL ~_~0~ ~
<br />~;2~.3 !SROQK~IDE DR NE ~7~02
<br />PHONE:
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<br />VALUATION:
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<br />~WIOTH: ~H; ~ AR~At UNITS J IRREG LO?~ ~R~: ................... ,
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<br /> TY~: O~iTE S[~ I WATER ~UPPLY: PW
<br /> I T~ST HOL~
<br /> PERMIT OR APPLICATION NO: ~671 ~ SITE EVALUATION NUM~ER:
<br /> : EXISTING TANK SIZE:
<br /> CONTRACTOR. NO, J EXISTINg ~RAIN FIELD LINES:
<br /> PAUL, STEVEN ~ : SEPTIC TANK ~UMPED:
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<br /> 1~21~ BROOK~Z~E DR NE ':~7~82 J '~'
<br /> PHONE: 678-5414
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<br /> ITeM : , '.'.',..,,~', '",,,, ':'"' .',,, ',. · QUANTZT7 AMOUNT
<br /> ,, "-'~: .. ,.,, '.' 1 $125~8e
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<br /> ,:;L"... ~ :", :',',~"',~':T'HI~R~Bt~T-,::~,: :. · $8.8B
<br /> ,~.,~?,:~;,,.:.:~,., ,,,,,2 .p.~,~,~.,..;::.r.. , ... ".i',/.,,.',.'.'~ .:
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<br />D~'NALD E. WOODLEY, NARI'ON'CouNTY, , BUIE])IN~",,[~FFI~;'IAI: / ~.Y i,_ ............... -;~ ..........
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<br />~o~,, ~c ~r.~ .e,'.,,~ OFFICE COPY
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