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MARION COUNTY <br /> • ~= Building Application 5155 Silverton Rd NE <br /> anon Salem,OR 97305 <br /> country. Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> O,R,E.G O;N <br /> 555-23-004265-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Ace Septic Tank Service <br /> PO Box 9177 <br /> Brooks, OR 97305 <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Accessory Structure $0.00 <br /> Description of Work: MAJ REP: SHOP(REF EXP APPLICATION 21-002739 FOR SOIL NOTES) <br /> '14"` r 1 ; . M V¢,0 JOB SITE.INI`ORMA#0. ` t t, ' i l <br /> Property Address: Parcel: Owner: MATHEW R COELHO JR RLT <br /> 9177 Silver Falls Hwy Se,Aumsville,OR 97325 082W13DB00100-Primary 50% <br /> Address: PO BOX 25997 <br /> FRESNO CA 93729 <br /> . >_ :.,,. , 5,. aLICENSED PROFES$1010AI.TNpORM; TIO#41M zA" x .V. a.l. <br /> Business Name License Address Phone <br /> ACE SEPTIC TANK SERVICE Installer/Pu 33013 PO BOX 9177 BROOKS OR 97305 (50-3)-393- <br /> mper <br /> License <br /> ," ,,",,,:; .. :L4j, OR:M17 FEES= .elk Oit a ta.,.e T.r. e riba ff:.. <br /> Fee Description Quantity Amount <br /> Repair(major) -single family dwelling 1.00 Ea $600.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $700.00 <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:05/19/2023 1 std_BuildingApplication pr <br />