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FOR OFFICE USE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br />2~o High SU~et N~ <br />.Salem= OR 97301 <br /> <br /> ~ OD a.m ~4 30 p.m F'hone 5~-514 7 <br /> C~-Ph~ <br /> FAX 5~-~ <br />SITE EVALUA~ON APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1, Localion of Installation <br /> <br />2. Installation <br /> <br /> .... r~. ~- ~ <br /> <br /> ('o~ra¢or ]~u~mu~ Name ~ Numar M~lmg Ad~s~ ~ P~o,~ N~ <br /> <br />~. Septic I~form~io~ (O~¢cl ~¢~ appli~ble) <br /> <br />e~L, 4. Fee Schedule <br /> <br />TotalAmount D.e:; $~ <br /> <br />T(L~t HOICg Ri~tdy: <br /> <br />Will Call When Test Holes Ready: <br /> <br />This is a technical report for on-site sewage disposal only and does not grant or <br />imply permission to build orr this parcel. Plarlning approval, construction and septic <br />3ermits must first be obtained before building or septic installation begins. <br /> <br /> <br />