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FOR OFFICE USE ONLY <br /> <br />ReceWed <br /> <br />eAR ON COUNTY'BU LD NG INSPECTI~.,, <br /> 220 High Street NE <br /> Salem, OR 973o1 <br /> <br /> $;00 a.ffl,~;3e i=,m, Phone 588-5147 <br /> Code-A-Phone 588-7g04 <br /> FAX 5~-794~ <br /> <br /> SITE EVALUATION APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1, Location of Installation U ~ 5~ piCniC ~ <br /> <br />4. Fee Schedule <br /> <br /> Sim EvaSion Fee: <br /> <br />s.&C> <br /> <br />3. Septic Information (Chick where al3pllcable) <br /> <br />Test Holes Ready: <br /> <br />Will c-~! When 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 bu[Icl on this parcet. Planning approval, construction and septic <br />permits must first be obtained before building or septic installation begins. <br /> <br /> <br />