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~85 Church SL NE Room <br /> <br />IZoning-Validation: Salem, Oregon 97'301 <br /> <br /> 24 hr. Inspection Line 588-7904 .. ~ <br /> <br /> SIT~ ~VALUAT~ON AP/OR sErn¢ P~murr APPLICATION 'I'~% T~. <br />L LOCATION OF INSTALLATION <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />Mailing Address Phone No. <br /> <br />3. FEES <br /> <br />~te ~valuatwn, ~mgie Family Dwelling, ea addl lot .............................................................................................. ::~:~ ~ <br />Site Svlduatio~, Commercial 1000 - 5000 g~Ilon~ .......................................................................................................... $2~.00 + $100/$0~ §allons <br /> <br />Single Family Dwelliug, Major Rep~ (draintield) ........................................................................................................ 215.00 <br /> <br /> Receipt: <br />NameofApplicant (PleasePrim):~ ~/e~/, ~/~, ~' ~,~ e'/~ TestHolcsReady: <br />Signature of Applicant:, ._~f~~ Da~e: ~ ~ t~'- Tank P umpeA: <br />MC I5-SI Rev 1/95 Pumping CerfificatJon Attached: (Y) (bi) <br /> <br /> <br />