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• <br /> • .. w� <br /> • <br /> Marion County <br /> OREGON <br /> COMMUNDEPAITYRTMENT DEVELOPMENT <br /> SEPTIC TANK ABANDONMENT <br /> THE SEPTIC TANK AT: V l « 004 POSE <br /> 1450 Na,r >> 14w <br /> ACTIVITY NUMBER: Q7— 02105 i <br /> WAS PUMPED BY: Ii*c3 j � 't t, S-QV Vti CQ� <br /> (licensed .Q. pumper) <br /> DATE TANK PUMPED: <br /> THE T AS: <br /> REMOVED <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 /> FILL MATERIAL: <br /> [] REJECT SAND <br /> [.] BAR RUN GRAVEL <br /> (] CRUSHED ROCK <br /> [] OTHER: <br /> ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> COMPANY NAME: /. 5QL -.c4.43.e <br /> SIGNED: DATE: 9Tv9 77 <br /> Marion County Building Inspection 3150 Lancaster Dr.NE,Suite C V <br /> F.D <br /> Salem,Oregon'97305-1398 <br /> Phone:588-5147 <br /> D <br /> SEP - • •.,,,,7 <br /> � ivvl <br /> abandon.mk 4/97 MARION COUNTY <br /> MC-15-S2 <br /> BUILDING INSPECTION <br />