Laserfiche WebLink
Application for Onsite For City Use Only: DateStamps <br /> Wastewater Treatment System City of <br /> 13EIC-E[IVE -1 <br /> Date Received <br /> MARION COUNTY PUBLIC WORKS Received by D <br /> BUILDING INSPECTION DIVISION Zoning by JUN 15 2023 <br /> 5155 Silvertonild NE Fee MARION COUNTY <br /> Salem OR 97305 <br /> (503)588-5147 Tax(503)588-7948 Receipt BUILDING INSPECTION <br /> www.co.marion.orms/PW/Buildinulnspection Activity# <br /> 'Property(Winer:Information. - ' " ' - <br /> Ferschweiter Intermodal, LW 6800 Le Brun Road NE Woodburn,Oregon 9,7071 503-371-3013 <br /> Name Mailing Address City,State,and.Zip (Area- Code)Phone# <br /> , e _ <br /> B:j.,egal.Property Description <br /> Sec 15,taS, Fl2W,W.M. 400 39:52 aP <br /> Legal Description Tax Lot Acreage orLot Size <br /> N/A. N/A N/A <br /> Subdivision Name Lot Block <br /> 6800 Le Brun Road:NE Woodburn OR 97071 <br /> , . <br /> Property Address City State Zip Code <br /> Directions to Property: From I-S south turn left on Hillsboro-Silverton Hwy NE,turn left on Butteville Rd heading south, <br /> turn right on Le Brun Rd NE,head west for approximately 1.4 miles the site will be on your left hand side <br /> t:lx:iiting,#acititY•kOtoPiasid Facility I Water Information <br /> Existing Facility: Proposed Facility: Water Supply: <br /> nSingle Family Residence El Single.Family Residence OPablie <br /> Name <br /> Number of Bedrooms Number of Bedrooms 0 PriVaie, Well <br /> 0 Other Farm Field El Other Commercial Well,Spring,Shared <br /> '- - -- :''' " to'.l'',i)6.of Application: . <br /> El Site Evaluation 121 Renewal Permit I:Authorization Notice for; <br /> El Construction Permit El Permit Reinstatement 0 Replacing a Dwelling <br /> 0 Repair Permit El Permit Transfer El The Addition of One,or More Bedrooms <br /> 0 Major El Minor 0. Existing System.Evaluation. El Personal Hardship <br /> c) Alteration Permit 0 Record Review Ei Temporary Housing <br /> El 'Major 0 Minor. 0 Other 0 Connecting to an Existing System Never in Use <br /> (over 5-yrs old) <br /> CI Other—Please Specify <br /> If therequired fee and attachnients are not included With this application,it will be'returned to you as incomplete. <br /> Post the orange card at the entrance to the property. Flag the;test holes. <br /> By'my signature,I tertifYthatthe information I have furnished is correct,and hereby grant Marion County,authorized agent of the <br /> Department of Environmental Quality,permission to enter onto the above described property for the sole purpose of this application. <br /> Tyler Roth 503-400-6028 <br /> Applicant's.Name—Please Print L.egibly Applicant's Phone Number DEQLic.# (if applicable) <br /> 3700 River Road N., Suite 1 <br /> Applicant's:Mailing Address <br /> 05-30-2023 <br /> Sign, Date: CCB# (if applicable) <br /> Applicantis the 0 Owner D Authorized Representative g.Authorization to Apply form Attached <br /> F:\FORMS\SEPT1 \S-01 ONSITE APPL SEPT 2622:DOCX Rev I/15,3/18,6/22 <br />