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FOR OFFICE USE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High S~et NE <br /> Salem, OR 97301 <br /> <br /> 8:00 a m ~4'.'.30 p.m. Phone 588~147 <br /> Code~.-Pho~e 588-7904 <br /> <br />SITE EVALUATION APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. Location of InStallation <br /> <br />3. Septic Information (Check where al:Jpllcable) <br /> <br /> Proposed No Bedrooms; ~ E~i~Img No, <br /> <br /> Single F~fy Dw~g , <br /> <br />/~, Fee Schedule <br /> $i~ Eva.l~a~ <br /> <br />Test H~les Re..ady: <br /> <br />Will Call Wher~ Test Holes Ready: <br /> <br />This is a technical report for on-site sewage disposal only and does not grant or <br />imply permission to build on this parcel. Planning approval, construction and septic <br />permits must first be obtained before building or septic installation begins. <br /> <br /> <br />