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MA RION COUNTY BUILDING INSPECTION <br />Z20 High Sm~et NE <br /> Salem, OR 97301 <br /> <br /> 8:00 am - 4:~0 pm Phone $$8-5147 <br /> Codo-A-Ir'hone 5gg-7904 <br /> FAX <br /> <br /> ~/1'1'1~ EVALUATION AND/OR SEPTIc PERMIT APPLICATION <br />1. Location of Installation <br /> <br /> 2. Contractor I?0formation <br /> <br /> 3, Fees <br /> <br />Sand <br /> ~'r~cnch <br /> <br />Ule D0watering <br /> <br /> ) <br /> <br />gyps, Minor <br /> <br />Cons~00~ Permit Ren~w~ (No Field Visit) <br /> <br />Aa0mriz~iOn N~i~e ~o Field <br />Annual Evulu~iq,~, Of Alternat~st~m <br />Annual Evaluat~ Of ~e <br /> <br /> ) l will call w~n 'I~sl IIo1~ <br /> <br /> ) I am a register~ buil~r ~ ( <br /> <br /> ) <br /> <br />Cr°ss <br /> <br />Capping F~II <br />Digmeal 'fi'~:~eh in Saprolito <br /> <br />Sump <br /> <br />Au~ho~zatJon N~it~ (Field Visit) <br /> <br />NAME OF AiPPI~ANT,(plea~e pri~). ' ......... <br />SIGNATURE OFAPPI.ICANT: DATE~ <br /> <br /> <br />