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, 41,4% , t s6 -,• ri,-5,416, . <br /> . . <br /> ./., • • _ • <br /> -, . <br /> .,., :. . " - MARTON COUNTY PUBLIC-WORKS: <br /> '' * BUILDING IN C:'1'1oN DIVISION" ., <br /> �:-�` 5155 S[vcrtonRdNE <br /> • Salem OR Y7305 - <br /> .- f -. (503)588-5147. FAX(503)58g=7948 <br /> htfp f/publicirorks:ca.marion,or.us%buidh/g/ <br /> • <br /> " • ' S1PTIC TANK ABA DONMENT FORA <br /> THE SEPTIC.TANKAT: • 9-5 -5 Oat 11-4,--- , -- <br /> . <br /> ACLlYTl'YNUIvfBK:- ,. . <br /> WAS PIThiPED BY: .. <br /> DRQ_Liter se#.. <br /> DATE TAhi1PLiMPU: <br /> ENCLOSE A COPY OF THE70114TING RECEIPT WITH THIS FORM. - <br /> THE TANK WAS; . <br /> 4Rov7 . <br /> . [ ] _. Errs: . <br /> • (NOTE: The bottom..of the.tank shontd be perfarafed or eracke3 to.i 1uhibit the <br /> acc maulafion of surface watet in the tank) . <br /> • <br /> • .. . . - - `ILL,M4 : . <br /> L 1• REJECT SAND - - • _ <br /> • • , [] : .BAR RDN GRAVEL - <br /> [ .. CRUSHED:R0(214_ <br /> CONMPAIIY NAME:. y'"`--k-- :;,D , k.,••..:::::::e; :5 L p.- -c.;5. <br /> f DALE .• "`'' <br /> SIGNED:: � . .. �'w--�-'..,.'�.,. <br /> • <br /> zc s oz • <br /> rev:6/G3 <br />