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Zoning <br /> <br />MARION COUNTY BUII.DING INSPECTION <br />220 l-llg~ $~reet NE <br /> Salem, OR 97301 <br /> ~':00 am- 4:30 pm <br /> <br /> FAX <br /> <br /> SITE EVALUATION AND]OR SEPTIC PERMIT APPLICATION <br />1. Location o[ lmtallatioo _. ~ ,~a ~ <br /> <br /> I T~ ~ ~o~ . <br /> ......... I . <br /> <br />2. C oi~ tl~[n for t~m tion <br /> <br />Fe~ <br /> <br />Cornnteveial (DSF-Daily Sewage Flow) <br />Redundant S~m 2~-~ 10+~ <br />~pa8~ ~ 2~.~ 10.~ <br />Plaa R~viow <br />(except SA~ FIIZERS) .... <br />F~ ~ a~itio~.~ g~. ~F 20.~ <br />Cons~cuon Permi~ R*~,~l (Fidd ~[~) 120.m <br />d ~ ~Uon Nm~ (g? d V~ ),,, 12[~ ,,[0,~ ...... <br />. .?nnual Evaluafi~ q[ ~ System ....... 75.~ 10.~ <br />Pum~r Track l~mion, Fkmi ~c~ .... 5~ffi <br /> <br />$1~ l~',,aluatiou, fu~llot ;20,00 $... <br />Si~ Ev~, ~. ~l. I~ ldS,~ 20,~ <br />~ng ~11 .................................. ~.~ IO.~) <br />.,2~m~wa~ m~*~ Sum~ 95.~ ~o,~ <br />Holdi~ T~k .......... 2~.~ lO,~ <br />~ ~fl~ 280.~ 10-~ <br />~u~ ~ 10,~ <br />Cons~on Peril ~new~, ~o Field Visl0 70.~ 10.~ <br />Au0~doa N~{~ ~iold ~t) { 120JX) 10.~ <br /> <br />Anpual Eval~fi~c~. ~ H~flio MH 7~,~ <br /> <br />SIGNATURE OF APPLICANT= <br /> <br />DATE: <br /> <br /> <br />