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..- - , -Li -_:: ---, 1 <br /> .. <br /> • x . LI. MAR 22 2019 <br /> e . <br /> C_T ; <br /> .,. •,_• •,. , <br /> MARION COUNTY7 ' <br /> BUILDING INSPECTIO <br /> ..,. <br /> 0. , Existing System •Evaluation Report for 1 i <br /> . • 11Preii",„ Otitite.',WistewOor Systems e r.. <br /> R*. IL''N-4 State of:Oteg'en Department of inetroareetttlit Oskiity :-.4'i <br /> aftscdown, . <br /> - emdiftiobou 01** :.P'Srurt . <br /> airmn& I65 4st 7-AWN"8.1•148 190 H <br />, . "lir Beene:01800119701 • • :iiit,. , <br /> FOr mote inforrnaton; vistWaiw.brestOngo4DECOWQ/pagesksistweeOticsingt Please onewerbe <br /> foltewrog questions as tiotrOtelaiy eis nost .Refer to OAR:3404171-4155. <br /> ill1111111. VPIIPIONlaelli.r.PMIWPAIOMA .c _ <br /> • SeptzlOystesi Ownet infetniationz <br /> . : <br /> PxolnitY Ownetts0elleks): .6::---„/. h",..A.-z......c.,,,,-t.‹....L.. Telephone: 73'1 17' 1.7.1-1:)-- <br /> Sift Address:talcl. C k-rii-t /1 ki4 cit : 6--Pt4-4-3 ap Code.: <br /> covnty: (Ink.r-.1 9 i"-) Lot Size: li _ Aaesaquare Feet. (circle naitS) . <br /> . <br /> .4gal Pettion: <br /> Age of wastewater Upson*sysietn. • (yeats) • i <br /> Date the sego tank wes last peniped (please sitackreeei*if amiable)- <br /> The eqmvehriehnation is flve.and to the belt of li bileitod84 , <br /> :. • . . <br /> Dam(DDAINfintri) .;,/ <br /> Sime of Owner <br /> !lune Of petson,performing inspection(please prhO 1€17:141 Zeitle<" ! <br /> ent <br /> ral bistallet " El PuSfessionsi Engineer , <br /> • <br /> m Maintenance Proriltier. El Enirkownentallieshre Specialist <br /> 101 :Natio*At.4...4osiation:orckras!**Nttii recheigiass 0 %sews=Spedelitt , <br /> Li Other DEQ:approved to.*nom(please desothe) <br /> Cortifiention Number: . 1.7"--113W -.. . <br /> Business nana44145 ..f4ic -‘4,4 dee/4$oftC-ail it)(4. • . <br /> Bashiess address iij(ic rhone51"34(POV . <br /> . <br /> ' . <br /> Pate of Inspection: t 7-e...—-7--0-( 4., . yyry) <br /> I hereby eadify,by.m avatars,that'ineet all of the qualificaticons reonired to performs et** <br /> wetatewater system inspect:WS In the state of Oregon pursuant to BAR 30-071 55. <br /> ' "i / <br /> • D,Ae . Siguetore Of''•.,fi, Septic SYStent htspeolox <br /> - . <br /> I . <br />