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FOR OFFICE USE ONLY <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem: OR 97301 <br /> <br /> 8 00 arn-4 30 p rn Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br /> SITE EVALUATION APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Location of Installation <br /> <br />2. Installation <br />Pr, lpcn> O~ncr Ma/ting Address & Phone No <br /> <br />3. Septic Information (Check where applicable) <br />[Propos~t No gedr~ms~ Exi*ting No Bedmms:: <br /> <br /> Wider Supply Well City ~ Stung ~ <br /> <br />4. Fee Schedule <br /> <br />Evaluation <br /> <br />Receipt No <br /> <br />Total Araount Due:: <br /> <br />Test Holes Ready:: <br /> <br />Will Call When Test Holes R¢,ady:: <br /> <br />This is a technical report for on-site sewage disposal only and does not grant or <br />imply permission to build on this parcel. Planning approval, construction and septic <br />permits must first be obtained before building or septic installation begins. <br /> <br /> <br />