Laserfiche WebLink
&3bbll <br /> Application for Onsite Date Stamp: <br /> Wastewater Treatment System <br /> Mit 1. II 1J j <br /> MARION COUNTY PUBLIC WORKS I' 1 ,t <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE OCT 18 2C23 <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 MARION <br /> www.co.marion.or.us/PWBuildinaInsnection 3UILDING <br /> 36th St Property LLC -Richard Kraft 3661 Kashmir Way SE <br /> Name Mailing Address <br /> Salem, OR 97317 <br /> CityxState,and Zip (Area Codc)Phone# <br /> r.v.� <br /> -/LEi:gal:Propert Descript on ,.x.. . . <br /> 5144 36th Ave SE Salem OR 97317 <br /> Property Address City State Zip Code <br /> 08 2W 18B 1000 4.54 <br /> Parcel# Tax Lot Acreage or Lot Size <br /> from Kuebler south on 36th on left. <br /> Directions to Property: <br /> C:;Existiug Facility I ProQosed Faciht /Water Information <br /> Existing Residential: Proposed Residential: Existing Commercial: Proposed Commercial: Water Supply: <br /> septic tank and drain field (to be removed)/ Holding tank ['Public <br /> proposed to be installed with 1 person maybe per week usage. o ees/ Name <br /> seating y Private <br /> Well,Spring,Shared <br /> i ll .? e ofAP_ptieaon _, �A _. ., <br /> ❑ Site Evaluation ❑ Renewal Permit ❑Authorization Notice for: <br /> ❑ Construction Permit ❑ Permit Reinstatement ❑ Replacing a Dwelling <br /> ❑ Repair Permit ❑ Permit Transfer ❑ The Addition of One or More Bedrooms <br /> ❑ Major ❑ Minor ❑ Existing System Evaluation ❑ Personal Hardship <br /> ® Alteration Permit ❑ Record Review ❑ Temporary Housing <br /> El Major El Minor ❑ Other 0 Connecting to an Existing System Never in Use <br /> remove existing system and install septic holding (over 5-yrs old) <br /> ❑ <br /> tank Other—Please Specify <br /> If the required fee and attachments 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 certify that the 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 /> 36th Steet Property LLC-Richard Kraft <br /> Applicant's Name—Please Print Legibly Applicant's Phone Number DEQ Lic. #(if applicable) <br /> i <br /> 3661 Kashir Way SE Salem, OR 97317 richard@kraftrnasonyinc.com <br /> Applicant's Mailing Address Email: <br /> ,or f iA 8-25-23 <br /> Signature- - Date: CCB# (if applicable) <br /> Applicant is the ® Owner ❑Authorized Representative(form attached) <br /> G:\BUILDING INSPECTION\FORMS\SEPTIC\S-01 ONSITE APPL JULY 2023 REV 6.23.DOCX Rev 1/15,3/18,6/22,6/23 <br />