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1. <br /> <br />thc following <br /> <br />Stayton, Mill City i $1zver~on ~ep~c ~e~vxces 34916 <br /> <br />~ao~z~TY o~.,_~. Kevin Deborah Jennings <br /> Dr. <br /> Aumsville, OR 97325 <br /> <br />SEPTIC TANK MATERIA~ Con~re%e XX <br /> <br />XX YES; NO <br /> XX NO <br /> <br />'{ 000 <br /> <br />DIAGRAM 0}' HOg$~ AND <br />LOCATION OF TAJIR: <br /> <br />example; <br /> <br />/lev 7/89 pb <br /> <br />SIGNATURE <br /> <br /> <br />