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MARION COUNTY BUILDING INSPECTION
<br />~ENATOR IBLDG, NO, 225
<br />220 HiGH ~TREET NE
<br /> SALEM, OREGON 97;~0~.
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<br /> PHONE: 588-5147 8:00- 4;30
<br />24 HOUR COOE,.A-PHONE: 588-7904
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<br />I am a te(;lisle fed builder OR { ) Ihe authorized repre~entatNe
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<br />~IGNA?URE OF APPLIGANTi ................
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<br /> 1,508t PARK AVC
<br />: LJm~ Oi~ ~ LO~NG ....................
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<br />'i~iUN'4 4 b~ ~'s~ ........................................
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<br /> 15061 PARK AVE
<br /> AIJRORA~
<br /> PHONE':
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<br /> .................. ....................
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<br />,~ - ~-~ ;..--.-~ -.{
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<br />TYPE: ON-SiTE SEI~GE J WATER SUPPLY; CW
<br /> ~ TEST HOLES READY'-
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<br /> J EXISTIN~ TANK SIZE:
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<br />ACE SEPTZC ..:'~"~'"~":'~::~"'~t"~:~T'~C";'T~RK':P~flPE~
<br />622~ [ARE LAVISH NE , PR[V~QUB fiD.
<br />f:'HONE: ~9~,-1~ ~ V:~F:i','""~..., ~ '
<br /> ., ,,,/,"; ~'; ).-..-. ':,?;?J ,~
<br />] TEH ' ..:~."7:L ....,. ,:::,, ,,,~".:~; ',,~ 2,?{,,~].'. "....?.: 7 ,,~,, ,,. ~UANTiTY A~OUfl'F
<br />STANDARD ON-S~TE SYS'TE~ '..'::~J'.":.,'.¥',~',':,.~":' ~" '~,~. '~:':.'-' V',' ,"" :' .: 1 $28~, ~
<br /> ,',.::.'?.~ ..': ..,.. ?.,: '.: ,
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<br />PAYEE:
<br />RECEIVED BY~ cl
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<br />SEE ATTACHED 1)OCUHENT
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<br />CON~II:,U[,TIQI, F-AIL~ TO
<br />ZOI'!ING O~DrI,1ANCE."~ THI.9
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<br /> $280, ~0
<br /> ::
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<br /> ~ iNVOIC~
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<br />FR~ ITS ISSUE
<br />ND MARION ~OuHTY BUILDING Ah~I)
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<br />R~i, HANKS.'. SB: SI'l) ' "" ' ' ' A/~
<br />l)l.}i,~A~..)) ~. {jOl.'jl)!,,.~y, MAR[OH Cf!UNTY BU~LD~IY~ OFFICIAL / BY ~- ....................................
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<br />OFFICE COPY
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