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/ ,~ <br /> FOR CITY USE ONLY <br /> <br />Zoning Validation: ~ <br />Date: ~ ~-~'- '~t~/ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY D£VELOPMENT C[NTER <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> . FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />Phone No. <br /> <br />Phone No. <br /> <br />3. FEES <br /> <br />+ $100/500 gallons <br /> <br />+ $251500 gallons <br />+ $25/500 gallons <br /> <br />Name of Applicant (Please Print)' ~ 6¢.,-~- D. ]~//~/'a ~ ~ <br /> <br />Date: 7 <br /> <br />Test Holes Ready: ~f- "~ - ~' t~ <br /> <br />Tank Pumped: <br /> <br />PumpingCerlification Attached: (Y) (N) <br /> <br /> <br />