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MARION COUNT! <br /> Building Application A lication 5155 SlIverton Rd NE <br /> MarionriMarionSalem OR 97305 <br /> counry 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> OREGON <br /> 555-22-005281-PRMT <br /> www.co:marion.or.us building@co.marian.or.us <br /> Applicant: Lone Pine Corner Septics Inc. <br /> 8778 Cascade Hiahway. NE <br /> Silverton,OR 97381 <br /> .ey.,•, •.,; •^'s'' r'ff. s x .� i -� '' ' <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 tee.,/ Z• Z <br /> i .• r - .. ak.i*wk .Z�_ ,. _ «a -E 1h ., ° �:zr °,.' ' .,F _.,�..».:P :'°ze_n... L' A4 , 6 <br /> Property Address: Parcel: Owner: <br /> 2664 Bodhi Ln Ne,Salem,OR 97305 <br /> ze...a c ., ea 7,a 1 Address: <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 /> r-ae. .:7 ; ,, ,�, -® <br /> 41%, ,, ., mom x ., x a _ ti R .s �.� w. -r " <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 /> Ail persons or entities performing work under this application are required to be licensed <br /> unless exempted by ORS 701.010. <br /> Printed an:os/-4fzoz2 1 sid BuiidingAppfication_r <br />