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FOR CITY USE ONLY <br />Received By: ~(-.- _ <br />IZoning ValidatJ. on: <br /> <br />MARION COUNTY BUILDING INSPECTIO~!~ <br /> COMMUNITY DEVELOPMENT (.'.ENTER <br /> 285 Church St. NE- Roc~m 132 <br /> Salem. Oregon 97301 <br /> 8:00am-4:3Opm Phonc 588-$147 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICA <br />LOCATION OF INSTALLATION <br /> <br />[._...'NIABION COUNTY <br />BuL~BIN G INSPECTION <br /> <br /> ...... Bedmom~ ........... <br />Section [ ..... Tc,wnshlp /~ 5 ~nge ~ Zon* Map Wa~r Supply: <br />~tWid~ {.,.~ ~tDepth 75 AemS ~. ~ l~g.~t Cgm*r : Co~unitTWdl ( ) City <br /> <br />2. CONTRACTOR INFORMATION <br /> <br /> Mailing Address I Phone No. <br /> <br />3. FEES <br /> <br /> 3i;¢ Emlaati(m, Rural Area Var/~mce .............................................................................................................................. 325,00 <br /> <br /> Single Pamily Dwelllng, Major Repair (dr~nfield) ............................................................................ ,215,00 <br /> : Al~atlons2 ................................................................................................................................... <br /> <br /> ~mp or ~slng Siphon ....................................................................................................................... <br /> <br />Signature of Applicant ~ ., Date: ~ ~ qhnk Pumped: <br /> <br /> <br />