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MARION COUNTY <br /> Building Application <br /> 5155 Silverton Rd NE <br /> $ W� Salem,OR 97305 <br /> County Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> OREGON <br /> 555-21-010675-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> • <br /> Applicant: American Underground, LLC <br /> PO Box 160 <br /> Sublimity, OR 97385 <br /> - - TYPE Oak WORK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Accessory Structure $0.00 <br /> Description of Work: NEW INSTALL for SHOP/BATHROOM <br /> 1013 SITE INFORMATION..,, <br /> Property Address: Parcel: Owner: CAMERON LT&CAMERON, <br /> 3916 Sunset Hills Dr Se,Turner,OR 97392 092W18B 01900-Primary FORREST W THE <br /> Address: 3916 SUNSET HILLS DR SE <br /> TURNER OR 97392 <br /> LICENSED PROFESSIONAL INFORI!+MATION <br /> Business Name License Address Phone <br /> AMERICAN UNDERGROUND,LLC Installer 39374 PO BOX 160 SUBLIMITY OR 97385 (50-3)-687- <br /> License <br /> PERMI't'FEES F <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 1.00 GPD $750.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $850.00 <br /> Note:This may not include all the fees required for this project. <br /> This application will expire if application acceptance cannot be achieved within 180 days. <br /> All provisions of laws and ordinances governing this type of work will be complied with <br /> whether specified herein or not. <br /> All persons or entities performing work under this application are required to be licensed <br /> unless exempted by ORS 701.010. <br /> Printed on:10/22/2021 1 std_BuildingApplication_pr <br />