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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE; 588-5147 8:00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occupy. <br /> <br /> of a registered builder. <br /> <br />Other_ <br />I have read and ~gree to the terms stated on the reverse side of DATE; <br />this document. <br /> <br /> ~&6,~ K~SE.. CT NE <br /> F'HONE ~ 982-896i ¢ <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />C, ONTRACTOR,~ bEL, 19575 <br />S'[?[lley M Keightley <br />1;~640 Oat{ Rd NW <br /> <br />PHONE= 868-7%88 <br /> <br />51054 <br /> <br />WATER SUPPLY: C <br />TEST HOI...ES READY: <br />SITE EVALI_IA'I'ION NUMI~.;R: 4-25--91 <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANE PUMPEI): <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITFN QUANTITY AMOUNT <br />SfAI'IDARD ON-SITE SYSTEM I <br /> TO'~AL :A~SES~E~ FEES "'>~"'" '' <br /> .~._,~., <br /> PREVIOUS RE6EZP'f9 ~.~ ...... o:'-' ~8' - <br /> THIS RECEZF'T <br /> <br />PAYEE: :'.; <br /> ; :: : INVOICE NO: <br />RECEIVED BY: gL <br /> <br />m:'l= AT'IACm ' OCU m,IT <br /> <br />CONSTRUCTION FAILS TO ME,_T ALL R:EQUIREM:NTS 81-STALE LAWS AND MARION COUNI¥ BUILDING AND <br />ZONING ORDINANCES, T~IS FERMIT oHALL BECOME NUE'L :AND ,~0II)., <br /> <br />RE."tARi';S:..~o':~'",, LOT ~::t. 8 <br /> <br />I)Oi,!AI..D E. b~DODI...EY, MARION COUNTY BUILDII,tl; OEFICIAL / BY <br /> <br />FORM # MC 15-~$ REV, 4/'30 OFFICE COPY <br /> <br /> <br />