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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> County 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> O.N <br /> 555-23-004157-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: <br /> A Affordable Septic Service, LLC <br /> PO Box 818 <br /> Canby, OR 97013 <br /> • No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified AGEX $0.00 <br /> Description of Work: NEW INSTALL: AGEX BLDG 6 EMPL <br /> < * $ e P` 3 r OB SITE INFORMATION r we a i" <br /> Property Address: Parcel: Owner: HIGHWAY 99 LLC <br /> 12120 Ingalls Ln Ne,Woodburn,OR 97071 051W04 01001-Primary <br /> Address: PO BOX 1130 <br /> WILSONVILLE OR 97070 <br /> lIGENS U`A P.ROFESSIO AL INi=ORMATIO[�I, x s` fi "` _ <br /> Business Name License Address Phone <br /> A AFFORDABLE SEPTIC SERVICE,LLC Installer/Pu 37918 PO BOX 818 CANBY OR 97013 (50-3)-682- <br /> mper <br /> License <br /> FEES ....��. �� � ...�....,... _., <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 150.00 GPD $1,010.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $1,110.00 <br /> Note:This may not Include all the fees required for this project. <br /> • <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:05/17/2023 1 std_BuildingApplication pr <br />