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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> ,` Permit NA503-588-5147 <br /> FAX: 503-588-7948 <br /> ORE G O N <br /> 555-20-004636-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> ° <br /> Applicant: Lone Pine Corner Septics Inc. <br /> 8778 Cascade Hiahway. NE <br /> Silverton, OR 97381 <br /> 1 :.1..__ Jp 37 , ° x TV PE, , WQRK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MAJ REPAIR FOR EXIST 3,BDRM RES <br /> Property Address: Parcel: Owner: MEHLHOFF FAM TR <br /> 9565 Elkhorn Woods Cir Se, Lyons,OR 97358 093E02DD00500- Primary <br /> Address: 4767 LISA ST7 NE <br /> SALEM OR 97305 <br /> r s LICENSED PROFESSIONAL INEB ATIQ � , <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 /> t <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:07/07/2020 1 std_BuildingApplication pr <br />