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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 <br />CODE-A-PHONE 4::30 PM - 8::00 A M <br /> <br />SIGNATURE OF APPLICANT __ <br /> DATE <br /> <br />DATE; 03/07/89 TIME: <br />OWNER <br /> <br /> LA_HAPELLE JOAN <br /> SITUS ADORES,S <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br /> 6064 SHAW LANE <br /> <br /> USE OF BUILDIN(.5 <br /> <br />PHONE; <br /> <br /> SE <br />OR <br /> <br /> CONTRACT CITY <br /> <br />F'!ARZ ON COUNTY <br /> <br /> SITE NUMBER; <br /> VALUATION: <br /> <br /> 24 8S 2W <br />4.OOOOO AC NO <br /> <br />UGB <br /> <br />NO <br /> <br />REST DENTIAL <br /> <br />OCCUPANT LOAD <br /> <br />NO O¢ BEDROOMS <br /> <br /> 66?6 <br /> <br />ZONE MAP <br /> <br /> AR ~- 5 1 <br />CORNER <br /> <br /> NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PEP34IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />LACHAPELLE, JOAN <br /> <br />PHONE; <br /> <br />9014340 <br /> <br />WATER SUPPLY; ~ <br />TEST HOLES READYr <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE= <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: 1/24/89 <br />PREVIOUS NO. 8EOROONS; <br /> <br />ZTEIvl QUANTZTY AMOUNT <br />REPAIR ,~ MAJOR I $80 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THiS RECEIPT <br /> <br />$80.00 <br /> $o,o0 <br />SSO.O0 <br /> <br />BALANCE DUE $0 00 <br /> <br />PAYEE: LACHAPELLE, JOAN RECEIPT NO: 152!0 <br /> <br />RECEIVED 8Y: DM .................................. TYPE: OK CHECK ~¢ 3091 <br /> <br />SEE ATTACHED DOCUM~T FOR REQUIREM~4TS OF ON--SiTE SEWAGE SYSTEM- <br /> <br />* THIS IS NOT A PEF~IlT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST SE COMPLETED. IT IS THE RESPONSIBILI~f' OF THE APPLICANT TO ASSURE THAT <br />ALL NECE.SSARY INFORI'CC, TION HAS BEEN PROVIDED. <br /> <br />REMARKS; REPAIR ~7244 <br /> <br />CITY JURISDICTION; 8¥. ........... DATE <br /> <br />["ORM # MC ,~,S6 REV ,,,88 OFFICE COPY <br /> <br /> <br />