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<br /> Application for Onsite Y' . . - • . •':-,'
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<br /> For•city.1.164..: -•---- -. . . . i !:- :;) ta s*P..
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<br /> ! . ,•!-,•:-.'..-„-•:-.: ,- Wastewater Treatment System• ,-. '':c4y•°f• •- . - - ' ' ..--. . . • •
<br /> - - :- DatelteceiV Received
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<br /> MARION:COUNTY PUBLIC WORKS • Itqqeiveit'llty•-,•'.•by .•..- .
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<br /> :_otriLDINGINgr!kGTION.,1)1Vitio)$•::;;: • . , :zoitifig by•:-.... -- --i:,-.--:,,: -
<br /> -.,--!!: :::• - : - - 5155: •Sitieton:itd:NE-..; .• • ''',' " • ' .• '•' .. :F i-•:
<br /> •.Salemt 10,97305 .- . - •:: ..,..... . .
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<br /> • (6040).588-5147..' Fax(503)$88.;7:9413;- '. 14443t1ij- ..... :. . •
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<br /> -:.*VV.Iicio.fillidOn4e:•tis/PW/BuildiliebasiDtioll- :::i Activity• • :'','
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<br /> Lisa J Barnes as Trustee of the Tristen Barnes Irrevocable • ..• : . ,. . ... ..
<br /> Investment Trusttiated December 15,2015. •. •.. P.O Box 45.94...- - . :.. . *.Ralii.m nR 97302 .... ..: 50351 95Q46:
<br /> ..Nanie::.'•:I. .....-.:•._:••- -:.,,.. :I:; ;... :: .:;Nati Atkiii.tii :.:.'..: ,,: . .•:..-...,•:,'„::::"'.;:C. ..;'..Stitte.,".ind'Z' .;:::::::;••.„:.:::,..,.....;:..,•:..,. _;:;i.•:•AireitCode••1111One#". :....
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<br /> Townshig 9P,Ftange 1W,Section 4B,'Tax Lot 1700,Section 5 Tax Lof400,Manor'CbuntY.• TaxLcit.170.0,5.400... • ••• ,-:!.•— --‘:..2....-4,_7_7,- - :..- - ,... : --• : - :;
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<br /> Legal Description• - •-•• • - - --:.•• ' •• Tax Lot • .. .. -. : . A•04•&•,..cit,'40tsi,i •-: •.-:::•• - •• " ,. ..
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<br /> Subdivision Name • .. •..." :' •• • • :4ot:. .. .. ... ...... ' .. :, . .... Block
<br /> ill crgof qui,Rd ... Aumsville
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<br /> Property Address ,:i• -- • • ...• .•••••-•:::. toy.. •• - .": . . • .. ... . .. .
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<br /> Dittotiois.to,rotopirtyt. E.-KA.::/g.,7.7. 0. 60(4 C-/d7.7.-r-F/54/71- as-.7Cr.— Q'e'' •....44(.........thr-eX..-10..47.‹,c
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<br /> --47,,„..7-44:•mxtu•,qt,:,%tgolt-•,..4.::irtt•ton--7:4if,tw, -4:,:•• ?7.-.411;;;;i•-.....x.74•77-...77::....-mtT,,,1„:.,.,,,r•-_-:of,...:;,,,,;-„,.,..,:.r -.,-,-wimirtivito;.1.7„4„4.titt..‘,.74-7folj.reiirati ..i ;
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<br /> Facilitytiopood . .
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<br /> n&Family Residence CSiogliFamily Residence
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<br /> .:•''N.#0bei.:;-of Botio6tri. - • "'1,1ii? lBeatootut.:- " 11:41iiiiitia.•4.P.IrlfO. ..aeZ. !
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<br /> ..a Other::: • . -.. ;,. .- r•;:-.. • • • .17.3 -Other:- . . . ...•.... . . : Well,Spring,Shared
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<br /> :1':':CtkistOclitiiiNtinit::, ''Et•,,Poonit*iiisiiionient. ::.: -L•J Li.--i':.R4D1041ik.D*ell.iii.. g.• . . :::. .-' ' ,,„, . . ..... .
<br /> 1=1 Repair Permit ; ... - al''- Pett*./ .T*Psf.-01; • , • '. The Additiond One tellOteBedrocimt•
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<br /> •.. • 01-MitjOts"•0,:...m.toot Ai-pristipg:;:sy$tati..EyalOittioo E1 Personalar4ohip_... . -. ,-.,• .-,
<br /> 0:AliptitAiiiitffeittO*•- •• 0:',gtOotcl.-1 .!446*.' :••• - • .a Temporary HoO.iii3g. . '.-. • .• • . .
<br /> la MOO:•:El Minor- --.:- ,•::0:-Other, - , ..:;. . . . :, 0 Connecting to attf.g*igtiiiesiAttomlievoisiiivs :
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<br /> DI:Oilief-PleiseSi5edify,
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<br /> :.ffth*fie4kiteilifeeilgid:oiticiOhileig14tinotipolgiAil:***Es,OpiiIi00107 .impli*roknodo).9.44id*:inefiiiip:14#0.
<br /> Post the orahge:card at the t ance to:the;property::Fiag the..tatiOks. - ... ..:•.. - .. :. County,..,..„ . .:. • ...• .:-._:.. . . .,.._. ...i . ..-;
<br /> By my iiiiiiittre;,Tbeitifytlititthe:'.jorOttattfiOtt I hti,Ve.forOLsbedJO,oqt$pt;an4•40oby•kt*tiMiFj.c*.ilaittio.ii*d::jtgvflhe,
<br /> pc...tattoo:cm:Of EnVitoithieptaiOial40etin*sitni-to*Oter"onto the itliOve..dOctibeti:propett!for ttkO,40.4..p4i00e..otAiis;apislic,ition.,.
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<br /> Michael R Barnes,Trustee8,Lisa 4 Barnes,Trusted .,. ,,. 503-510-5046 ... . :.... • , .. . ... . . i
<br /> APO.liatinti.6 Name'' 'X:.*F45:111*Legibly•• Applicant's Phone Number.... ISQ'1,16:.'# i•(ifitppliOttly10).:.--•* .••
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<br /> P 0 Box 4594,Salem,OR 97302 ---- .
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<br /> Sigootot :.' •- - Date. y :,-:CC15:# (
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<br /> :App'cant ipt.lie. .. O.*flets El.Authorized Representative ::EJ Authorization to Apply form Attached
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<br /> Fts .ORIVISN.Sirli • i'-.ONItE 41,16L:Iiitx 2022txDCX Rev ins,3/18;6/22
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