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M <br /> MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG.NO.225 <br /> A SA EM, OREGON 97301 HIGH STREET NE HISTORY <br /> PHONE 588-5147 <br /> CODE A PHONE 4.30 PM.-8 00 A M- <br /> r i am portorming work OA a property I awn or occupy <br /> ( 1 t mrep registered builderd OP f )the auUt0d2ed reproacntatrvc 81awwLRE of AP?U ANT <br /> a <br /> (( i The rwpd W U be Perfortiled IN a rCglstorad builder <br /> { 3 I O rood and <br /> agree to the teens stated on the reverse side of DATE --- —..•_-_. <br /> this <br /> °"ATE: 05/31/88 TIME: 1:SO:43p Tax LOT CATEGORY <br /> srrusAooaEsSSTANTON. BESSIE OOMertruoTION,YPE OCCUPANCY RESI DENT I. <br /> CONTRACT CITY UGS OCCuPAM LOAD <br /> KEIZE50 CHEMAWA RD OR 97303 N <br /> use of swLDING KEIZER NO NO or ocoaOOU <br /> MAILING ADDRESS a0DneSION 3 <br /> 4673 HAYESVILLE DR NE <br /> SALEM 97305 <br /> PHONE: 393-3480 SITE NUMBER: 7427 <br /> LOT &LOCK SECTION TOWNSHIP RANCVALUATION: z0NE faav <br /> MN OEPTH AREA 4 uNrts 75 IRREG LOT 3W COrbm 73.2 <br /> 9_00000 AC NO NO <br /> TYPE: ONSITE SEWAGE WATER SUPPLY: PW <br /> • TEST HOLES READY: <br /> PERMIT OR APPLICATION NO: 16280 SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br /> CONTRACTOR, NO- EXISTING DRAIN FIELD LINES: <br /> STANTON, BESSIE SEPTIC TANK PUMPED: <br /> 4673 HAYESVILLE DR NE PREVIOUS NO. BEDROOMS: <br /> SALEJM 97305 <br /> PHONE: 393-3480 <br /> TEM QUANTITY AMOUNT <br /> EXISTING SYSTEM EVAL. RPT. 1 $100.00 <br /> TOTAL ASSESSED FEES $100.00 <br /> • <br /> PREVIOUS RECEIPTS $100.00 <br /> THIS RECEIPT $0.00 <br /> • BALANCE DUE $0.00 <br /> PAYEE: • <br /> RECEIPT NO: <br /> RECEIVED BY: c'1 TYPE: CHECK #: <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON—SITE SEWAGE SYSTEM. <br /> * THIS IS A VALID PERMIT * THIS PERMI EXPIRES 350 DAYS FROM ITS ISSUE DATE_ IF <br /> CONSTRUCTION FAILS TO MEET ALL REQUIRENDITSOF STATE LAWS AND MARION COUNTY BUILDING AND <br /> ZONING ORDINANCES, THIS PEY1IT SHALL BEGONE NULL ANO VOID. <br /> REMARKS: AUTH FOR LOAN RU6801 <br /> DONALD E. WOODLE'Y. MARION COUNTY BUILDING OFFICIAL / BY Qt <br /> FOMA r IAc is-se Ar v nine OFFICE CO"r <br />