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OREGON <br />COMIVlU NIT~ DEVELOPMENT <br />DEPAR]~ENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br /> EP 29 t3~? ~ <br />MARION GOUNTY <br />BUILDIN6 INSPI::¢TIOh <br /> <br />DATE TANK PUMPED: <br /> <br />THE TANK WAS: <br /> t~ 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 />[ ] REJECT SAND <br />[ ] BAR RUN GRAVEL <br />[] CRUSHED ROCK <br />[] OmER:~d bttrrted <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />COMPANY NAME: /..-O,,rse,,.~ <br />SIGNED:~ DATE: -~L_~- ~ <br /> <br />abandon, tnk 5/96 <br />MC-15-S2 <br /> <br />Marion County Building Inspection <br />285 Church Street NE <br /> Salem, Oregon 97301-3670 <br /> Phone: 588-5147 <br /> <br /> <br />