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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 HOIdR,'CODE-A-PHONE; 588-79O4 <br /> <br />sm pedormil19 Wo~ on ~. ~roparl~ t'(ywn.m r.~ct~p¥.' ' , ~ ."; " " ' : · ' ' · "' ", ' ' <br />a~ a r~ist~fed builder OR ( ~ the authorized representative. SIGNATURE OF APPLI~NT:,, ...... ~ .... . ....................... <br /> <br />DATE= I~/21/9~ T~HE= 1[=17=5~ ................ <br />8188 ~iLVER FALLS HWY <br /> <br /> s~a~ ~ f- ....... ~ ............................... <br /> PHONE: 581-1~87 ~ VALUATION. <br /> <br /> ~7~I .o~/4 r~4 1..I: ...... 1 ........ - .... <br /> <br />TYPE= <br /> ~-SZTE <br /> SE~CE <br /> ~TER,'SUPPLY= P~ <br /> ,,I TE87 ~[ES ~EA~Y: <br /> S~TE EVALUATION NUHBER: <br /> EX~STIN~ <br /> T~NK <br /> SIZE: <br />CONTRACTOR. NO. 3491& ~ EXZSTINg ~RAIH FIEL~ LINES: <br />STAYTON SEPTIC ~ SEPTIC.T~HK PUHPED~ <br /> <br />PHONE': 769-23~2 ' ~ . <br />REPAIR ~AJOR ~ ~: QUANTi~Y AMOU~I' <br /> <br /> PAYEE: <br /> <br /> SEE ATTACHED' ~OCUMEWTI <br /> ~ lltZS IS ~ VALID <br />CONSTRUCTION FAZLS TO <br />ZONINg DRDINANCES~ <br /> <br /> RECEIPT ND: <br />TYPE: CHECK <br /> <br />$125.00 <br /> <br />$0.00 <br /> <br />MARION COUNTY BUILDING AND <br /> <br />~ ~ ~c ~-~ R~v.,~ OFFICE COPY <br /> <br /> <br />