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<br /> Site Address: Sci S )-1'
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<br /> Total Acres MAR 10l*,&4(.1NTY':'
<br /> TAxtoy BUILDING 1110PECTION
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<br /> '5959 57TH CT SE, SALEM
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<br /> Aldan Bammes . `•
<br /> I certify that the above Information Is accurate to the best of my knowledge.I AM THE I I Owner or I I Authorized Agent.
<br /> NAME(please print):13tac.c_ / c;'...--(..e...-- Telephone II f_50,3-q/1 -73-
<br /> Applicant's SiLmat Date:.//—.o.9,-,2.
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<br /> City 'a(rn1 Zip: q 7.2 i 7 Applicant's email: 41/1e&r .....eyin-ic:.1/ /.cizatesi ,!;•..q. )14"''''
<br /> S-3I-6-2020 G:Worras\SeptieWORMS\.S-3 la ScptieSystemSitellanItequirements for SUE_EVA LS_2020-07-20.doe >
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