Laserfiche WebLink
• <br /> - - MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> 111111 Salem OR 97305 <br /> (503) 588-5147 FAX(503) 588-7948 <br /> http://publicworks.co:marion.or.us/building/ • <br /> • <br /> • SEPTIC TANK ABANDONMENT FORM <br /> THE SEPTIC TANK AT: (tit 3 pcgor'h4e <br /> `)E <br /> s Q /leArL.- <br /> • ACTIVITY NUMBER: ��S°� Z �'oC2 9 --_ -- <br /> • WAS PUMPED BY: • ��- � � • <br /> • .DEQ License# - (3 • <br /> . DATE TANK PUMPED: ` 7- / - a <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH TM'S FORM. <br /> • <br /> THE TANK WAS: • • <br /> REMOVED' _ . <br /> [] FILLED • <br /> • <br /> (NOTE: The bottom of the tank should be perforated or cracked to prohibit the <br /> accumulation of surface water in the tank) <br /> FILL MATERIAL: <br /> [] REJECT SAND <br /> • [] BAR RUN GRAVEL <br /> [] CRUSHED ROCK . • <br /> COMPANY NAME: ' • <br /> ,SIGNED: • - TE: 7- (2 <br /> MC S-02 . <br /> rev:6/03 . <br />