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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> iVanon Salem,OR 97305 <br /> ;County 503-588-5147 <br /> Authorization NA FAX: 503-588-7948 <br /> O.R:E'.G'O.N <br /> 555-23-004352-AUTH <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 /> 0,1 k� " "S PP } C `` -Hx-7&.,.. Oti, 046Itteir :lS v JON..vY ,e . s � ,riaa.r <br /> �'R T k''a� �f� � sse 1"f X d�. <br /> had �.. 1� r �:,.'� ., <...., ,.,m.`..;; <br /> • No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br />' Description of Work: AUTH TO ADD FUTURE HARDSHIP(SYSTEM FAILING,SEE MAJ REP) <br /> _.b v. 3OB SSITE INFORMATIOG+i �a <br /> Property Address: Parcel: Owner: PALLAS, DENNIS W& <br /> 18508 Mt Angel Scotts Mills Rd Ne,Scotts Mills, 061E16D 00700-Primary PALLAS,CHERYL L <br /> OR 97375 Address: 18508 MT ANGEL SCOTTS <br /> MILLS RD NE <br /> SCOTTS MILLS OR 97375 <br /> ..,, 401 ' ° ,y kili- UCENS D P,RO SHS ,f t i L? N0Rb1[A Tt3N,a ,," <br /> Business Name License Address Phone <br /> LONE PINE CORNER SEPTICS INC. Installer 37003 8778 CASCADE HIGHWAY,NE SILVERTON (50-3)-873- <br /> License OR 97381 <br /> d ... ,„...t fd%t,�.Ag<iftgg.,. ..< A.E:f-k 4 4lakkkO���"tWOM r, ..°sAR.kVtg ._aka,.hri01, <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $605.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $705.00 <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:05/23/2023 1 std_BuildingApplication_pr <br />