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OF SATISFACTORY C, Oi'viPLETiON <br /> MARION O_OUISIT~. ~/~""~ <br />~)MI~IIJN]TY DEVELOPMENT DEPAR'fMEN"i' <br /> BUILDING INSPECTION DiVISiON <br /> mO HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> PHONE: 588-5147 <br /> <br />OWNER: <br />ADDRESS: <br />INSTALLER: <br />SEPTIO TANK: <br /> NO. GALLON~: <br /> MATERIAL: ~.~,,,~,,~_..,r, ,,~' f,, ,, ,, ,, ,, ,, ,, ,, ,, ,~ ~ ..... <br /> MANUFACTURER:_~,~ ~- ~'~ ~. <br /> <br />BUILDING SEWER MAT'L: <br />EFFLUENT ~EWER MAT'L: <br />COMMENTS: <br /> <br />....., ON-~T~S. EWAGE SYSTEM INSTALLATION INSPECTION <br /> <br />~ PERMIT NO, <br /> <br />DISPOSAL FIELD: <br /> TOTAL LENGTH: <br /> PIPE MA'r'L: <br /> TRENCH DEPTH: <br /> ROCK DEPTH <br /> DIST. TO WELL: <br /> <br />In accordance ,,~ith OregOn Revised Statute 454.665; this certitieste"'i's issued as evidence of satisfactory <br />completion of a subsurface or alternative sewage disp0s~tl system at the above location. <br />iNSPECTED B'~ DATE: 74/'~.".% <br /> TITLE: / " ..... <br /> <br /> <br />