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Marion County Building Inspection 5155 Silverton Rd NE-PO Box 14500-Salem,Oregon 97309 Phone: (503)588-5147 Inspection Line:(503)373-4427 Check your Permit Status On Line at:http://publicworks.co.marion.or.us/building/ SEPTIC APPLICATION DATE: 03-26-2013 TYPE: MINRPR ACTIVITY N0: 13-01815 OFFICE: MC USE: C STATUS: APPLIED MAP: 7 SITE: GFWH APPLIED: 03/26/2013 ZONE: EFU EX?IRES: 09/24/2013 DESC: MIN REP TANK ONLY FOR EXPIRED PERMIT 07-01390 SITE ADDRESS: 21579 CHAMPOEG CREEK LN NE S? PARCEL: 0424412 01300 APPLICANT: ANDEREON,MARK J & CATHERINE PHONE: 503 678-3333 ADDRESS: 21579 CHAMPOEG CREEK LN NE ST PAUL OR 97137 OWNER: ANDERSON,MARK J & CATHERINE PHONE: 503 678-3333 ADDRESS: 21579 CHAMPOEG CREEK LN NE ST PAUL OR 97137 OCCUPANT: INSTALLER: PHONE: LICENSE N0: ADDRESS: Existing Bedrooms: 2 Proposed Bedrooms: 0 Total Bedrooms: 2 Existing Employees: 0 Proposed Employees: 0 Total Empl.: 0 Existing Seating: 0 Proposed Seating: 0 Total Seating: 0 Description Fee Units Description Fee Site Evaluation $0.00 Authorization with FV $0.00 Rural Area Variance $0.00 Authorization without FV $0.00 New Installation $0.00 Auth/MajRep $0.00 Major Alteration $0.00 Auth/MinRep $0.00 Minor Alteration $0.00 Auth/MajAlt $0.00 Major Repair $0.00 Auth/MinAlt $0.00 Minor Repair $75.00 Record Review $0.00 Permit Renewal with FV $0.00 M TrUCks, Pumper Inspec $0.00 Permit Renewal without FV $0.00 * Pumps, Dosing Siphon $0.00 Plan Review $0.00 DEO Surcharge $60.00 MisC/Copy Fee $0.00 Refund Code $0.00 other Septic Fee $0.00 ATT Insp Fee/No Report $0.00 Total Fees: $135.00 Existing System Eval $0.00 Total Payments: 5135.00 Balance Due: $0.00 THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE SOIL, FEASIBILITY, AND INSTALLATION REQUIREMENTS ARE CHECKED PRIOR TO THE ISSUANCE OF A PERMIT. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT ALL NECESSARY INFORMATION IS PROVIDED. AS SOON AS ALL REQUIREMENTS OF THE REVIEW HAVE BEEN MET, YOU WILL BE NOTIFIED. THIS APPLICATION EXPIRES IN 180 DAYS. THE "ORANGE CARD" MUST BE POSTED AT THE COUNTY ROAD NEAR THE DRIVEWAY TO THE PROPERTY TO ASSIST STAFF IN LOCATING THE PROPERTY. BY MY SIGNATURE, I CERTIFY THAT THE INFORMATION I HAVE FURNISHED IS CORRECT, AND HEREBY GRANT MARION COUNTY, AUTHORIZED AGENT OF THE DEPARTMENT OF ENVIRONMENTAL QUALITY PERMISSION TO ENTER ONTO THE ABOVE DESCRIBED PROPERTY FOR THE SOLE PURPOSE OF THIS APPLICATION. SIGNATURE OF APPLICANT: X weie .2 WARREN n JACKSON,MARION COUNTY BUILDING t '91/LUAI hO.IEYER CALL BEFORE YOU DIG. IT HE LAWA . TIENTION.Oregon law requires you to follow rules adopted by the Oregon Utility Notification Caner.Thou rules are set forth by Oregon kdmiestrative Rules.You may obtain copies of the rules by Wog,be anter. (Note The @pMne number for Oregon NJMy Waterman Center h 1.800-3I 2-2344)