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I~O~'OFFICE USE ONLY[ <br />Zoning Va'lidatioll: <br />Date: <br /> <br />MA RION COUNTY BUILDING INSPECTION <br />22.0 High Smeet ~ <br /> Salem, OR 97301 <br /> <br /> 430pm Yaonc 588-514'/ <br />Co~A.P'ao~ 58g-'/904 <br /> FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />Location of htstalhiion <br /> <br />2. Contracte# ~[I]~r~ation <br /> <br /> 330l~ .10.~ ~yWg~lSu~ 95,~[ 10.~ <br />Via ~) ,120,~ 10,~ E~i~a~ Syaom ~:valoation ~ ~ ~ <br /> <br />(;,~ '~s! }lole~ arc Dug <br /> <br />NAME Q~APPLICANT (l~ka~ print): <br /> <br /> <br />