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~------~c~l OREGON <br /> <br /> SEPTTC TANK ARA~O~ <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTIVITY NIJMBER: <br /> <br />MARION COUNTY <br />RUILDING INSPECTION <br /> <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> [~ REMOVED <br /> <br />FILLED <br />(note: the bottom of the tank should be perforated or cracked to <br />prohibit the accumulation of surface water in the tank) <br /> <br />FILL MATERIAL: <br /> [ ] REJECT SAND <br /> [ ] BAR RUN GRAVEL <br /> [ ] CRUSHED ROCK <br /> [ ] OTI-ma: <br /> <br />barn d <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />COMPANY NAME:. L-&rse.~ ~ekko-c 5,-z'. <br /> <br />SIGNED: <br /> <br />DATE: q- 23 .q7 <br /> <br />Marion County Building Inspection <br />285 Church Street NE <br /> Salem, Oregon 97301-3670 <br /> Phone: 588-5147 <br /> <br />abandon.ink 5~96 <br />MC-15-S2 <br /> <br /> <br />