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MARION COUNTY BUILDING INSPECTION <br />SFNATOR 8LOG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE: B88-5147 8:00 ~ 4;30 <br />24 HOUR 'CODE.A-PHONIE: 588-7904 <br /> <br />{ am pedormin9 work on a p¢oDerty I own or O~¢uOy <br />I am & teglate~ed builder OR ) the authgtl~ed regreSentative <br /> <br /> WI gL ~AMB,_~JAC~IE ......................J... ...... <br />-s~¥~,~ -x ~,~.-¢~ .......................... <br /> <br /> 854'J. HQLM~UIST RD <br />AUMSVI'LLE OR ~7325SE <br /> <br /> PHONE: 749~390~ <br /> <br />TYPE~ ON-SITE <br /> <br />CONTRACTOR~ NO. 34~16 <br />STAYTON SEPTIC <br />41155 ~TAYTON ~ZO~ <br />PHONE: 7~9-2~2 <br /> <br /> [ ~A~ON COUNTYJ NO <br /> .... , NO. O~ <br /> <br /> .= 1. ~o ............ t ~ ~ , <br /> <br /> WATER ~UPPLY= Pa <br /> TEST ~LE~ RBA~Y: W/CALL <br /> ~T~ ~A~UAT~OH <br /> EXIST~H~ TAH~ ~IZE: 2~ <br /> EX~TING DRAIH Fi~L~ <br />~,, ~EPTI~.TANK. PUMPE~: 4-93 <br /> PR~V~' -~OJ'" <br /> <br /> REPATR - HAJOR ......... ' ..... QUANTITY Ai"IOUNT <br /> ' '"' '"' " .............. · <br /> <br /> ........ ,' ..~g~,~E~SE~.FEE <br /> · ' , ., '.'.~, .' ....... .. ' , <br /> ................... <br /> .............. <br /> '., , ,~ ~,: : ':x..'.,'..:U~-.; ;,::.~.:i'~E~.Z.PT/,:'.;' ~. :: <br /> ' <br /> ..... ~ ................ · ........... ~A~A~E. DUE. ., <br /> ........... <br /> <br /> ~E[ ATTACHED DOCUMENT ~FO~'}~EGU~R~KET~','~':O'N~.~,,i~¢:,!~w~ .................. <br /> ~ ~ ", ff. , ,, ,, ..... · ...... ., .;. , .. m ,,-~ ............................... <br /> <br />AL~ NE~u ,u~, u uuflyu~L~. Z] I~ .rUE .:RESPONS~DIL[Ty OF THE APPLZCANT TO ASSURE THAT <br /> <br /> PLAN E~VIEW: <br /> _ "CZTY JU~,S,DIC'TIOfl: BY, ........ PATE .......... <br /> <br />OFFICE COPY <br /> <br /> <br />