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• _ (5tD51 <br /> II JUL 07 2023 <br /> . . <br /> MARION COUNTY BUILDING:INSPECTION DIVISION MARION COUNTY <br /> EUILDING INSPECTION <br /> • <br /> 515Sal5Ziert°015884-891Rd340,75.14E.: <br /> (503588-1048 <br /> LAND USZCOMPA_ _TUMMY ISTATFAMT%MS/ <br /> FOR i:)N-SITE SEWAGE SYSTEMS <br /> DATE: :'7' '7 : 4D merit #: <br /> SECTION I—APPLICANT INFOR101ATION, <br /> 1.„ Property Address: ZiS7 •1:)..k t Av e. pmperty.m,#: <br /> De to" <br /> Stedon: Township: Range: Tax Lot Itt <br /> hlinne of Applicant k.t.Vi kak-teerktjo' Telephone it: 'crO3 --7 - 3:76 ti <br /> lviailing Address: <br /> 3. Describe type of facility the on-site:sewage syirem serve(biliinets.osidertce or other): <br /> ingiefarnily Residence <br /> l Biltinesn <br /> .Other: <br /> 4, Type or on-site sewage system permit application beiogpmpnsed•for this-pmperty; <br /> 0 New,laStallation Permit <br /> 173 Repair PerMit <br /> V.-Alteration Perrnit.for: 0 ReplacemontDivelling, Bedroom(s)addition <br /> Ci Other.changes in,land use involving potential sewage flow increase <br /> GIWORsaWsErnpAppacation liacket0539 tlICS:doc MC:S-39 revi 13110,1W12 <br /> . . <br />