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APR--29--96 MON 10:2~ AM St'a','~_onSe'.e'%._ic.&Const. rvq. t,n 50:~ ?69 3892 <br /> P. 02 <br /> <br />Marion, County <br /> <br /> OREGON <br /> COMA4UNITY DEVELOPMENT <br /> DEPARTMENT <br /> <br />,Uilding Inspection Division · Community Development Center <br />85 Church Street NE · Room 132 ° Salem, OR 97301-3670 <br /> <br />THE SEPTIC TANK AT: Yeloni Amsberry <br /> <br />8973 Shaw Sq. R~ SE <br /> <br />Aumsvllle~ 0re,on 97325 <br /> <br />NAS PUMPED BY: 8tavton, Mill City~ & Silverton Septic Services <br /> (licensed D.E.Q. pumper) D.E.Q. #34916 <br /> <br />DATE TANK PUMPED: <br /> <br />3-1-94 <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> <br />Ix] <br /> <br />FILLED <br />(note: the bottom of the tank should be per- <br />forated or cracked to prohibit the accumula- <br />tion of.surface water in the tank) <br /> <br />FILL MATERIAL: <br /> .[.] REJECT SAND <br /> [ ] SAR Rrm ORAVEL <br /> [ ] CRUSHED ROCK <br /> IX] OTHER: Dirt <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />DATEi'4-29-96 <br /> <br />SITE #: 94-39~ <br /> <br />&bandon.:nk 4/95 <br />MC-ZS-83 <br /> <br /> <br />