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IFOR CITY USE ONLY <br /> <br />eceived By: __ <br />IZoni. ng Validation: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:g0pm Phone g88-g147 <br /> 24 hr. Inspection Line 588-7904 <br /> FAX $88-7948 <br /> <br />SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> Pc ........... <br />................. Private. W*ll ( ) Spring <br /> <br />Phun~ No, <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />3. FEES <br /> <br /> Cesspool ............................................................................................................................................. 387-00 <br /> <br /> Seepage Pit ......................................................................................................................................... 317,00 <br /> Steep Slope ......................................................................................................................................... 387,00 <br /> <br /> Residential or Commo~-at.,,~.~ <br /> ................... r>.c.ce~......,~.co-zr m .............................................. ~g3.0o <br /> 'l'%-nlllTT~newal, Field Vlsi1; .................................... <br /> <br /> Authorization, Field Visit .................................................................................................................. 252,00 <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br />+ $25/500 gallons <br /> <br />Name or' Applicaut (Please Print); <br />Signal m't~ o[: Applicant: <br /> <br />Date: <br /> <br />Test Holes R*ady: <br /> <br />Tank Pumped; <br /> <br />Pumping C¢~lification Attached: (Y) (N) <br /> <br /> <br />