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MARION COUNTY <br /> COMMUNITY DI=VELOPMENT DEPARTMENT <br /> BUILDING INSPECTION DIVISION <br /> 220 HIGH STREET NE ^ ~ <br /> SALEM, OREGON 97301 ~1~v <br /> PHONE: 588-5147 '~ (,~ <br /> <br />.... ' ll I .il{l. <br /> <br /> ~ . O~-S~E ~WA~E SYSTEM INS~E~TION INSPE~ION <br />OWNER: ~ _ _SITE NO,.' ~t <br />ADDRESS; '~~~~ <br />INSTALLER: ~ . PERMIT NO..., ,, <br />SEPTIC TANK: DISPOSAL FIELD: <br /> <br /> MATERIAL: ' PIPE MA~L= ~ ~ 7.~.¢-'"~ " <br />MANUFACT~ TRENCH DEPTH: ~' <br /> ROCK DEPTH: <br />BUILDING SEWER MA~L: DIST. TO WELL: / <br />EFFLUENT SEW~ MAT'L; ~ ~ ~, ¢¢1~' _ BOXES: ~ , <br /> <br />In accordance ¢it~Oregon Revised Statute 454.665; thfs cer~ficate is issued ~ evidence of satisfactow <br />completion of a su~sudace or alternative sew~e disposal sy~em at ~e above location. <br /> <br />lh[SPECTED BY: <br /> TITLE: <br /> <br />DATE: <br /> <br /> <br />