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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00; 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7g04 <br /> <br />Sm performing work oa a proper~y ' own or occupy, ' <br />J 31Y, e ¢~gi~tered builder OR the authorized representative $~¢NATUR~ OF APPLIC ..... <br /> <br />The worf< will be pedormed by a registe¢ed builder.. ' ' <br />Other. ~ · ' ". <br /> <br />PHONE= /,78-5745 <br /> <br />VALUATION.' <br /> <br />)CDUPAN T LOAD; <br /> <br />93-!~2333 <br /> <br />TYPS= OH""~ITE SEI~gE <br /> <br />PERHIT 01% APFt[CATII~ #O: <br />~ONTRACTOR~ NO. <br /> ANN~ GLORIA <br /> <br />PHONE~ 678-574$ <br /> <br /> I WATER SUPPLY: PW, <br /> I TE~T HOLES READY. <br /> 9~149~.%~ ' I ~ITE EVALUATION <br /> ; EXISTING TANK SIZE: <br /> . J EXISTING DRAIN FIELD LINES: <br />:~:-' PREVIOUS NO, ~ROOHS: <br />~' -C': "'~ :'~h <br /> <br />QUANTITY AMOUNT <br /> <br />$160~00 <br /> $0.00 <br /> <br />· , , ~_~- . ~, f ~ ~. ~ <br /> PAYEE. HAHN GLORIA .- ..~ ~ ~ ~ .................... <br /> , ~ ~,,,~;~:~,,~¢fi:~.::..,....:.~., .............. ,,.,. .. RECEIPT NO. ~1370 <br /> RECEIVED.BY: CL2 .... ~. 7'~)~, ~C~tt':~x-,'y,r~ ~ TYP~ CK CHECK ~: 183 <br /> .................... ~. =~:c~:= ~'~ ..... ~YgTEfl. ' <br /> <br /> FOLLOUlN~ MUST BE COMPel ~~Z~~.[~%~F~THE APPLICANT TO ASSURE TUA'r <br /> ALL NECESSARY INFOEH~I~ ~-~~-~.~}.:.~'~ ~ :.~ :.* ':~: ' ~ <br /> <br /> ........... __:,,_ ..... , .. <br /> <br />F~'~";~J ~. MC 15-~ REV. 4,~0 OFFICE COPY <br /> <br /> <br />