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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br />8ALEM, OREGON 97801 <br /> <br /> P:HONE: 568-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />TYPE= ON-SITE ~£)4AGE <br /> <br />PERHIT OR APPLICATION NO-. <br />CONTRACTOR,, HQ, ~ ~ <br />~!TENNBCKt ROGER ~HEI,ITdl;: PLO,g) <br />AURORA ORE V"7002-8~56 <br />PHONE." 678-1431 <br /> <br />WATER SUPPLY= PW <br />TE~T HOLEg READY.- <br />~ITE EVALUAI'ION NUHBER: <br />EXI.~TII,I~ TANK <br />EXIST,IN6 I)RA'[lt. FIELD t...[HE~: <br /> <br />PREV~QUS NO. <br /> <br /> ITEM ... , ,-. ' DUANmT 1TY AM(1UN'F <br /> ETD OHSITE SY~ < ~0~ G'i~Li"i" ,,..;. '~.' ~ ":' :.. 1 ,'--'" <br /> <br /> : ;?.!F?'.;~., <br /> <br /> ~ BALANCE ~UE ~,, <br /> PAYEE: HDDUL. A~ CO'~CEFTS~ I:NC;. <br /> RECEIVED BY: DM2 ' · <br />BEB ATTACHED DOCUMENT FOR:' RE~OIREMENT~:.OF.:QH29ITE <br />~ TH~G IS NOT ~ PER~IT. 'THi'S"A'~i~O~,.~T, <br />FOI. LOWINg HPST BE COHPL, ET~)~;,. I'T.' IS'THE;-' RESPON~ZBZLZTY DF THE A>F'I :{OAR' 'rQ AS; ;R~ THA <br />ALL HEEE~SARY ~HFORWAT'.[ON' WAS ~EEN' PROViDE~.'~' "' ' - <br /> <br />REMARKS'! STD ~iY,'3'I'EM <br /> <br />CITY JURIBP:IC'I'ION: BY ............... <br /> <br />'fig ...... <br /> <br /> <br />