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FOR OFFICE USE ONLY <br /> <br /> MAR[ON COUNTY BUILDING INSPECTION <br /> 220 High Stceet NE <br /> ,Sa[em, OR 97301 <br /> <br /> 8a30 a,m,-¢:,.',',~ p,n~. Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 5~79,~ <br /> <br /> SITE EVALUATION APPLICATION <br /> <br />COMPLETE ALI. SECTIONS~ I THROUGH 4 <br />1, Location of Installation <br /> <br />2. Installation <br /> <br />No, <br /> <br />Mailing Add~:a &~ Phe~ No, <br /> <br />3. Septic Information (Check where applicable) <br /> <br />; Schedule <br /> <br />NO. <br /> <br />Test Holes Ready: <br /> <br />Will C,~U When Test Holes Ready: <br /> <br />51 matm'~ of Owner or Authori?ggl A cnt,<-~'[~ <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 inatallatfon begins. <br /> <br /> <br />