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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH S?R~=£T NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: $88~5147 8:00 - 4:80 <br />24 HOUR C. ODJ~A-PHONE: 588-7904 <br /> <br />DATE~ ........................... <br /> <br /> F'HONE~' <br /> <br />~kO¥ F~I~:}~ ...... 7~'~{~'~31~i - TOWN~H P; , RANGE ZONE, MAP <br /> <br />TYPE= {3N~S];TE S£WAgE <br /> <br />'~r':;'j '. ~ :': ........ L" <br />¢ M...4d... ;.. ,¢ <br /> <br />~ATER SUPPLY <br />TEST ~LE~ <br />~TE EVALUATION <br />EXISTING TANK SIZE: <br />EXZS'fXN6 DRAIN FIELD <br />SEPTIC TANK PU~PED: <br />P~EV!DU~ NO,, <br /> <br /> F'H Ol'.!iii;; 769--77U4 <br /> <br /> ,.. .............. NO,ICE '- FL.b, V!S~T t ~,.:.~,..'¢~ <br /> ,OTAL A~S~.SSED F~ES <br /> <br /> ' I~ALANC~ ~O~ <br /> <br /> :;~IF:CE')V;:'O 97:: ~¢~}: TyP~: <br /> ,R.,,_ A'fTACHED ~OCU~iE~iT FOR REQUIEEHENTS .OF' ON~SIT~ SEWAGE <br /> THiS ~ ~OT A PEE~IT. TH~S APPLICATION ~8T CO. TH~U~ A REV~E~ PROCESS WHERE T~E <br />FOLLOW];Nf; MUST B~ ' ~' ~"r~ ~ .,., ..... <br /> CO~fP~..E,~D., IS THE RESPONSIBILITY OF THE APPLICA~?~ TO TH~"j' <br /> ~ E~ L,h:~.:. <br /> .... ,~ ;]EM, _CN HAS r~EEN PROVIDED~ <br /> I,l,, ,,,E, S¢,R r _ . <br /> <br />P!...A:~.i ?U.:;//;(E!~:,. ~Y, ........................ !,~ATE ........................... <br />: 1]i;~AF,'K~h: ALrl'H <br /> <br />ClT'f 'JU'Fi'iSD:(CTIOJ,R, BY ................. [¢,qY'l:: ................. <br /> <br />OFFICE COPY <br /> <br /> <br />