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~TE~ <br /> <br />.Marion county <br /> <br /> OREGON <br />COMMUNITY DEVELOPMENT <br />DEPARTMENT <br /> <br />SUBSURFACE. SEWAGE COMPLAINT FORM <br /> <br /> BUILDING INSPECTION <br /> 220 HIGH STREET NE <br />SALEM, OREGON 97301 <br /> <br /> ~ /)EC 2 3 199~ <br /> , ~Amo~ <br /> ~UILDiNG INSF.~TiO~,, <br /> <br />ADDRESS OF <br /> <br />PROPERTY TAX LOT NUMBER: <br /> <br />SUBSURFACE PROBLEM - (Attach or draw map location) <br /> <br />oWNER.S NAME & <br /> <br />NATURE OF SUBSURFACE PROBLEM: <br /> <br />COMPLAINANT'S SIGNATURE: <br /> <br />It is this department's policy to keep the name of <br />ant confidential unless required by law to release. <br /> <br />any complain- <br /> <br /> <br />