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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 H~GH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />0ATE; 06/0?/88 TI ~4E: 2_- 35: 58D <br /> <br /> CHAPWESKE, N.J. & GERTRUDE <br /> <br /> 9684 SILVER FALLS HWY SE <br />AUMSVILLE OR 97825 <br /> <br />MAILING ADDRESS: <br /> <br />SIGNATURE OF APP~ICAN <br /> <br /> DATE: <br /> <br /> TAX LOT CATEGORY: <br /> RESIDENTIAL. <br /> CONSTRUCTrOh TYPE 'OCCUPANCY; <br /> <br /> CONTRACT CITY~ UGS; OCCUPANT LOAD: <br />MARIONCOUNTY NO <br /> <br />SAME <br /> <br />PHONE: <br /> <br /> 18 <br /> <br /> SITE NUMBER-~ 4605 <br /> VALUATION .' <br /> <br />8S IN AR3 <br /> NQ NO <br /> <br />' MAP: <br /> <br /> 46 <br /> <br />TYPE; ON-SITE SDNAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />CHAPWESKE, W.5. & GERTRUDE <br />SAME <br />PHONE: ~ <br /> <br />9008951 <br /> <br />WATER SUPPLY; PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />E3(ISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED; 6-1-88 <br />PREVIOUS NO. BEOROOf4S: <br /> <br /> ITEM <br />AUTHORIZATION NOTICE - FLD. VISIT <br /> <br />PAYEE: SANTIAM VALLEY HOMES <br /> <br />TOTAL A~ESSED FEES <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> BALANCE OUE <br /> <br />QUANTITY AMOUNT <br /> ! $105.08 <br /> <br />$105.00 <br /> $o_0o <br />$105+00 <br /> <br />$0.00 <br /> <br />RECEIPT NO: 9620 <br /> <br />RECEIVED BY: J8 ............. , __~,_ ;TYPE:CK CHECK ~: 8664 <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON'SITE SE1/~AGE SYSTEM. <br />~ THIS IS NOT A PERNIT. %14IS APPLICATION NUST GOTHROUGH A' RSVIEW PRGOE~ WHERE THE <br />FOLLONING I~UST BE COI4PLETED. ITIS THE RESPONSIBILITY OF THEAPPLICANT TO ~RE THAT <br />ALL NEC~SAA'Y INFORf~ATION HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW: 8Y DATE <br />REMARk%: AUTH NO. R~8359 <br /> <br />CITY JURISDICTION: 8Y .......... DATE <br /> <br />rO~M ,, Mc ,!~!~t~ ney ,~/,~ OFFICE COPY <br /> <br /> <br />