My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
12360854
Images9
>
Public Works - Permits
>
Building
>
FOR PUBLIC VIEW ON INTERNET
>
COMPLETED FILES - INACTIVE
>
24-XXXXX
>
12360854
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/27/2024 12:05:43 PM
Creation date
9/5/2024 11:37:46 AM
Metadata
Fields
Template:
Permits
Permit Address
11535 SILVERTON RD NE
Permit City
Silverton
Permit Number
555-24-006512-EVAL
Parcel Number
071W04B 00800
Permit Type
Site Evaluation
Permit Doc Type
Permit Document
Status
Ready to Film
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
11
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
Show annotations
View images
View plain text
, .14- 15i)Le5rd\ <br /> Application for Onsite Date Sump: <br /> � Wastewater Treatment System RECEIVED <br /> iiiiMARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION AUG 16 2024 <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 <br /> www.co.marion.or.us/PW/Buildingjospection <br /> :1, o e O ner'Tnfornia#01 <br /> 13vu51A IL_ P/4 5 Pei 13 -Ili <br /> Name ' Mailing Address <br /> 5111ir,'t, , a C r/361 <br /> City,State,and Zip (Area Code)Phone# <br /> B .egal Property Description _... _. - <br /> 1155- .fir'tG - tt1E St 1 -- . ne. ct73g( <br /> Property Address City State Zip Code <br /> ri t h.re c1 ,e5 C.r) 0'0 6 51' Irre-1 S <br /> Parcel# Tax Lot Acreage or Lot Size <br /> Directions to Property: <br /> C.Existimg 1 aciliii y/Pr'oposed Facility r Water.Information <br /> Existing Residential: Proposed Residential: Existing Commercial: Proposed Commercial: Water Supply: <br /> 9Q ` ['Public( Name <br /> Number of Bedrooms Number of Bedrooms Number of Employees/ Number of Employees/ p t(� - <br /> SeatmgW Seating ® Private ,rLre .s c <br /> ivr,G p,--4ywr,-5.. (P- ts� r Y4vhr e p g, hared '��`-k <br /> fx Site Evaluation ❑ Renewal Permit ❑Authorization Notice for: <br /> El Construction Permit ❑ Permit Reinstatement 0 Replacing a Dwelling <br /> ❑ Repair Permit- ❑ Permit Transfer 0 The Addition of One or More Bedrooms <br /> ❑ Major 0 Minor ❑ Existing System Evaluation 0 Personal Hardship <br /> ❑ Alteration Permit 0 Record Review 0 Temporary Housing <br /> ❑ Major ❑ Minor ❑ Other 0 Connecting to an Existing System Never in Use <br /> ,, --1, Ptifel- (over 5-yrs old) <br /> 4 / s J^ Flock (�P 44uvw y i^t�►lact t a,ti,1„J,,(t_.�rrc(G7' ' ❑ Other-Please Specify <br /> If the requiredfeeand 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 /> Oregon Sewer& Drain LLC 503-874-9414 38968 <br /> Applicant's Name-Please Print Legibly Applicant's Phone Number DEQ Lic. #(if applicable) <br /> PO Box 1282 Silverton. OR 97381 josh@oregonsewer.com <br /> Applicant's'. T§ Addr Email: <br /> l 1 1•o4/ 201683 <br /> S' a e Date: CCB# (if applicable) <br /> pplicant is the 0 Owner IN Authorized Representative(form attached) <br /> G:\BUILDING INSPECTION\FORMS\SEPTIC\S-01 ONSITE APPL JULY 2023 REV 6.23.DOCX Rev 1/15,3/1.8,6/22,6/23 <br />
The URL can be used to link to this page
Your browser does not support the video tag.