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12357532
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Last modified
9/27/2024 8:49:56 AM
Creation date
9/3/2024 10:18:59 AM
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Template:
Permits
Permit Address
1850 CHEMAWA RD N
Permit City
Keizer
Permit Number
555-23-005874-PRMT
Parcel Number
073W04 00800
Permit Type
Septic
Permit Doc Type
Permit Document
Status
Ready to Film
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..<3x:)g^n•)•;;<: ;:w,:;.;..;':.kX.;.�.:.y:.;...x<o:q:Z:u ,.�'�.. ?aka.^:":•%:f.':.;>.'.:":v`:+::;k�Si.':)5k"`;`!:$:;:;a:::'..•:'.Ra::'ta5�: ,:'•k`5�:; .3;K�;�:.•. ;F:;`y35.Y:';�:R��, <br /> :........:...............>f:+.1f:.ic:.:n:)`.:'.;::<•'%�:.M �'2&kt F.ka'.S4fR-),.�t-x1?�::.�t tirk,L),x.Ey^>.:f <br /> Marion County Building Inspection <br /> 3150 Lancaster Dr NE-Suite C <br /> ."' .. Marion_County `'' Salem,Oregon 97305-1398 <br /> . OREGON <br /> MI COMMUNITY DEVELOPMENT ;:; PIS 588-5147 ./<• <br /> DEPARTMENT ^{ p <br /> kf FAX#588-7948 `9 <br /> aSagatURNORREN::,:n...::.,'ln.61,'a3.:.-:no:;.)v`:".'..',#:f_#:.;..n:.bF. •3 <br /> • H <br /> SEPTIC SYSTEM CERTIFICATION <br /> PROPERTY OWNER: (lhar z A C. v,4vZt L. <br /> SITE ADDRESS: ,,,,;.c,,, ire.p • �+CS r7F2 (DA- <br /> ..�...�c — 9F'- /b/''L. <br /> ACTIVITY NUMBER: 0..•-3a R•-iq ,ea r.o- nsi Pt <br /> I certify that I have personally investigated the existing septic system on the above property and <br /> have identified the exact location of all parts of the septic system, including the septic tank, <br /> distfilmaties-box or-drop-boxes, drainfield lines and future septic system replacement area. The <br /> attached site plan is an accurate representation of the Iocation of the septic system and proposed <br /> structure(s) on the property, and the proposed development meets all minimum setback require- <br /> ments from the existing septic system,and the future septic system replacement area. <br /> I further certify that I have,to the best of my abilities,thoroughly inspected the septic system and <br /> • found no evidence of any failure. The system appears to be functioning in a satisfactory manner <br /> at this time. <br /> .- <br /> SIGNATURE: <br /> (li •. installer,septic consultant or owner) <br /> Name(please print): / l/l j1i Ai61 <br /> Company Name: j44163 1p4 <br /> Mailing Address: 1D L, (A),n Atr„ 1[,e ,eo A1b <br /> Date: <br /> MC15-S38 <br /> REV 6/98 <br /> I <br /> 1 <br />
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