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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: 588-7904 <br /> <br />~IG~ATURE OF APPUCANT: ............. <br /> <br /> T <br /> DA E ............... <br /> <br />PHONE: '~69'"5937 <br /> <br />SITE NUI~E, ER: ?3-00484 <br />VALUATION: <br /> <br />, <br /> <br /> TYPE.- OH-SITE SEWAGE WATER SUPPLY: PW <br /> TEST HOLES READY: <br /> PER~IT OR APPLICAT~[OH 1,10: 9~,&ie49 S.~TE EVALUATION <br /> EXISTING TANK S~ZE: <br /> CONTRACTO~ NO. EXISTING D~AIN FIELD <br /> <br /> " U,~';.~,.;~,~-'-~.';,.~,~::~,,t'..%: ~%,~'.J..;~; ~,".'.'..,',',' ..... <br /> <br />ALLFOI' N~C~SSARyOWING ~uSTiNFORHATioNBE COMPL~TE~;~:;~a~_~H~{~,' ~ ~O~,B~:L:ZFT'y:':.OF~... ~HE APPLICANT TO <br /> <br />R£HARKS,: HD,~]P <br /> <br />P?:;2 5 ~3 " <br /> <br />OFFICE COPY <br /> <br /> <br />