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A lication ford(-1- �Sa <br /> j't' <br /> Onsite Date Stamp: <br /> Wastewater Treatment System <br /> MARION COUNTY PUBLIC WORKS [1..i1H,CP,N1P-0 <br /> BUILDING INSPECTION DIVISION <br /> 5155 Siiverton Rd NE APR 10 2024 <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 MARION COUNTY <br /> www.co.marion.or.us/PW/Buiidinanspection BUILDING INSPECTION <br /> A Pro a Owner Information • <br /> Rodrick and Catherine Leabo 4924 Dehlin Ln <br /> Name Mailing Address <br /> Turner OR 97392 503-508-1556 <br /> City,State,and Zip (Area Code)Phone# <br /> B.Legal Property Descnptzon._ . . �3 � <br /> 4927 Dehlin Ln Se Turner OR 97392 <br /> Property Address City State Zip Code <br /> 2 acres <br /> Parcel# Tax Lot Acreage or Lot Size <br /> Directions to Property: :GSA r G- )r y4 6 0 L.,,J II 9s�,�,f ;aA� rg. <br /> c Z �� �.6 of eat_ e <br /> C, Existing Facility/Proposed Facility/Water Information <br /> Existing Residential: Proposed Residential: Existing Commercial: Proposed Commercial: Water Supply: <br /> DPublic <br /> Name <br /> Number of Bedrooms Number of Bedrooms Number of Employees/ Number of Employees/ private well <br /> Seating Seating <br /> Well,Spring,Shared <br /> D Type,of Apphca_tion ..'_ <br /> ❑ Site Evaluation : ❑ Renewal Permit ❑Authorization Notice for: <br /> �� Construction Permit ❑ Permit Reinstatement ❑ Replacing a Dwelling <br /> ❑ Repair Permit ❑ Permit Transfer El The Addition of One or More Bedrooms <br /> ❑ Major ❑ Minor ❑ Existing System Evaluation ❑ Personal Hardship <br /> El Alteration Permit ❑ Record Review ❑ Temporary Housing <br /> ❑ Major ❑ Minor ❑ Other El Connecting to an Existing System Never in Use <br /> (over 5-yrs old) <br /> ❑ 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 /> Bethel Excavating 503-743-2343 36198 <br /> Applicant's Name_Please Print Legibly Applicant's Phone Number DEQ Lic. #(if applicable) <br /> PO Box 504 Turner OR 97392 office@bethelexc.com <br /> Applicant's Mailing Address Email: <br /> 4-11-2024 44551 <br /> Signature Date: CCB# (if applicable) <br /> C:\USERS\ANAJERASANCHEZ\APPDATA\LOCAL\NIICROSOFT\WINDOWS\INETCACHE\CONTENT'.DUTLOOK\FKJL2DXT\S-01 ONSITE APPL JULY <br /> 2023 REV 6.23.DOCX Rev 1/15,3/18,6/22,6/23 <br />