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MARION COUNTY <br /> <br />NAME OF APPLICANT: <br />ADDRESS: <br /> <br />~INTER WA~R CHECK REQUEST <br /> <br />SITE EVALUATION FTLE <br /> <br />TAX LOT 0R ACCOUNT <br /> <br /> The applicant hereby requests a winter water check and hereby grants <br />permission to representatives of Marion County to enter the above described <br />property at reasonable times for the purpose of monitoring winter water <br />levels. The applicant understands that winter water checks are made during <br />the months of January or February, end during a winter in which normal <br />rminfali has occurred. <br /> <br /> Please return this application to Marion County Dept. of Building <br />Inspection, Senator Building, no. 225, 220 High St. NE, Salem, Or. 97301, <br />Telephone 588-5147. <br /> <br />SIGNATURE OF APPLICAN% <br /> <br />~%GNATURE OF OWNER, iF OTHER THAN APPLICANT <br /> <br /> <br />