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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> County 588 5147 <br /> Permit NA FAX: 503-588-7948 <br /> OREGON <br /> 555-22-005281-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Lone Pine Corner Septics Inc. <br /> 8778 Cascade Hiahway. NE <br /> Silverton, OR 97381 <br /> TYPE OF WORK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: NEW INSTALL FOR NSFD 3 BDRM /24,tee,/ Z Z , Z fir <br /> JOB SITE INFORMATION <br /> Property Address: Parcel: Owner: <br /> 2664 Bodhi Ln Ne, Salem,OR 97305 .-_TEMP MC Primacy Address: <br /> Z-c 730 ,�IID 7 li l <br /> LICENSED PROFESSIONAL INFORMATION <br /> Business Name License Address Phone <br /> LONE PINE CORNER SEPTICS INC. 8778 CASCADE HIGHWAY,NE SILVERTON (50-3)-873- <br /> Lcerse OR 97381 <br /> PERMIT FEES <br /> Fee Description Quantity Amount <br /> Install -Capping fill- by gallons per day 450.00 GPD $990.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $1,090.00 <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:06/14/2022 i std_BuildingApplication_pr <br />