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~ MARION COUNTY BUILDING INSPECTION <br /> SALEM. O.~ON 97301 <br /> <br />~AT~R,~UPPLY: <br />?~T HOLP.~ RF-.AOY: <br />SITE EVALgATiON NUMBER: <br />b'XiSTiN~ TANK <br /> <br />SEPtiC ~ANK PU~ED: <br />P~VI~JS NO. <br /> <br /> TA~ .a~ED FEEe, $55.00 <br /> PREvI(~JS RECEIPTS <br /> THZS R~EJP'T $55~00 <br /> <br /> PAYEE; '~'H~N ~RI~ RgC~lPr No: 33~31 <br /> RECE[VEO BY: c TYPE: CK ~ECK ~: 58~0 <br /> <br />* THiS I5 NOT A P~IT. TMi~ ~LiCAT[~ ~T ~ TH~ A RE~[~ P~ ~E~E THE <br />FOLL~I~T BE ~ETEO, [T 1~ THE R~IB$LITY OF THE ~PLi~NT TO ~RE THAT <br />ALL N~ INF~TI~ ~ BE~ <br /> <br />R~-MARKS: lANK REPLACEMENt R~433~, <br /> <br />,~, ~c ~-~ ~[~ ~ OF FICE COpY <br /> <br /> <br />