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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> Permit NA FAX: 503-588-7948 <br /> O R•E G'O N <br /> 555-22-004407-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Ace Septic Tank Service <br /> PO Box 9177 <br /> Brooks, OR 97305 <br /> .is.--�-r :; ..,,;,, <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MIN REPAIR TANK ONLY EXIST 2 BDRM RES J� <br /> Property Address: Parcel: Owner: JUDITH JAMES <br /> 6237 Arbordale Dr Se,Salem,OR 97317 082W04A 05000- Primary <br /> Address: 6237 ARBORDALE DR SE <br /> 4 <br /> 7 e '� 4if,UCENSED PROFE SI NAL,;INFORMATION <br /> SALEM OR 97317 <br /> ,w <br /> Business Name License Address Phone <br /> ACE SEPTIC TANK SERVICE Installer/Pu 33013 PO BOX 9177 BROOKS OR 97305 (50-3)-393- <br /> mper <br /> License <br /> 2 �,.✓.�0 _s,- ., 11tO F ° 31. ,''AW WEI4"?. 1 lint <br /> Fee Description Quantity Amount <br /> Repair(minor)-single family dwelling 1.00 Ea $100.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $200.00 <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:05/17/2022 1 std_BuildingApplication pr <br />