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MARIFIN P-ElUNTY HEALTH DEPARTMENT <br /> <br /> SAL~:M~ ~REt~3N ~'7301 <br /> <br /> (owner or person requesflnq ~>v~l~o11) <br />5-3-?3 <br /> <br />Sericd No, 5~73~5 <br />Fee Receipt No, 3810 <br /> <br />6625 Ng 8~_d AV~ .................. <br /> (~ddres~) <br /> <br /> Your reque~st dated.....~i~ ....................... ~Or property evcfluc~tJ~n in'accordance 'w~th Ore. on Admin- <br /> istrmive Rules, C~orpter 333, sections 41-001 to 414345 (PR~SALE inform~tio,n). <br /> <br />P;o~y 1,~:=t,o=; Sm~o~____._~ ..... ~-.1.-..~.,. ¢o~s~p_.A.$. ~r of ~ ............... <br /> <br />Field cheek g~p_erally conforms to soil recaps? /' attached'. <br /> <br />SCS conflrmmtlon needed? .... ~ ........... Y~ ~o <br /> Ye~ No <br />Wcr~er supply comments (if cmy) <br /> <br />Fecxsibility comments ............. <br /> <br />Copy to: State H~lth Division ~~ ~ ........... <br /> R~I Estate Commission ~e (R~i~te t Sanitarian) <br /> <br />EH-51 7/72 <br /> <br /> <br />