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FOR CITY USE ONLY <br />Re~_iv~d B~¢: __ <br />Zoning Validation: <br /> <br />IDate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> $:00am~4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 3734427 <br /> FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION .~ ~'~ ~, q~ <br /> <br /> City <br />~tWid~ /~' ~tDep~ /~,~ ~ I~g. Lot Comer ~unityWell ( ) Civ ( ) <br /> <br />2. CONTRACTOR INFORMATION <br /> <br /> Property Owner <br /> <br />3. FEES DE~ ~3~916 <br /> <br />Mailing Address I Phone No. <br />Mailing Address ~Phone No, <br /> <br />+ $1001500 gallons <br /> <br />+ $25/500 gallons <br />+ $25/500 gallons <br /> <br />Test Holes Ready: <br />Tank Pumped: /E' /]~.~ ~ <br /> /' <br />Pumping Certification Attached: (Y) N~~ <br /> <br /> <br />