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· ~*dR CITY USE O~JLY <br />"R¢¢¢ivedBy: ~ ~ <br /> Zo.ingV~lid~ion: g I <br /> <br />MARION COUNTY BUILDING <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br /> F~ 5~7948 <br /> <br /> /~3'q, ~o SITE EVALUATION AND/OR SEPTIC PERMIT APPLII~I[~I~I{~0Uh/TY <br />,.,~o¢,~io,~ o,~ INs~,~,.,~io~ o-~ q'q <:~4o~q r_~J~r4~ mP~OT~0~ <br /> <br /> o <br />Se~ ~ Toms~p [~ ~ Range ~S ~ne g-t -~.m-~ Wa~r~ply: <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />/'xStandard System ................................................................................................................................. 382.00 <br />Single Family Dwelling, Major Repair (dralnfield) ........................................................................................................ 210.00 <br /> <br /> $ <br /> <br />+ $I00/500 gallons <br /> <br />+ $25/500 gallons <br />+ $251500 gallons <br /> <br />Test Holes Ready: <br /> <br />Pumping Certification ~t~aehed: (Y) ((NJ} <br /> <br /> <br />