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FOR OFFICE USE ONLY <br /> <br />eARION COUNTY~BUILDING INSPECTIi~. ~ <br />2,~ High S¢$ot NE <br /> Salem. OR ~Ol <br /> <br /> 8.1X) a.m.-4:30 fi,m. Phone S88-5147 <br /> ~-A-Pho~a <br /> FAX <br /> SiTE EVALUA~ON APPUCATIQN <br />COMPLETE ALL $E~IONS, 1 THROUGH 4 <br /> <br />2. Installation <br />~ ~-- ~' / p~ ~ox /06~ 4. Fee SchNule <br /> <br />3, Septic Information (Ch~=l( where al3pllcable) <br /> <br />Rece/pt No, <br /> <br />Test Hol~ Ready: <br /> <br />V~qll ~ Wh~.T~st ~les R~cl.y: <br /> <br />Signature of Own~ Or Authofi~d Agent/~a~., ~ '~yr~ ~.tC/~C,i ~.l 'Fr 1~ ~0~ ~ iH~' / <br /> This is a technical report for on-site sewage disposal only and ~oes not grant or <br /> imply permission to build on t~ls par,~eL Planning approval, e~nstrucUon a~d septic <br /> permits must first be obtained before bulrdi~g or'septic tn~a'Jlafl0n begins. <br /> <br /> <br />