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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> county Permit NA 503-588-5147 <br /> FAX: 503-588-7948 <br /> G O.N' <br /> 555-23-004931-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Ace Septic&Excavating, Inc. <br /> PO Box 9177 <br /> Brooks, OR 97305 <br /> q A64✓�s .�E� 3'� '� � s.:�t g h`$ -Ls �`9-3, F .�' 9 a bw. 6 3 �£ ^5x % Ak; 3 §� <br /> , �_�. 3 d °R ra4-�;: .,A..x �,� ... H� a,.,e:,M w.. ..r. erm�FYPE O Wt7RK �q 99 . ..r , iU i o ..;. <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: MIN REP: 3 BDRM SFD REPL TANK <br /> ro.Y � K �3 3 ,� r ,� G � .,.,.., � fi— -,rt 6'� .e. <br /> �r,, y a a a . 30@ SITE ZNFORMATIQN a� . <br /> Property Address: Parcel: Owner: LARRY&VIRGINIA DALE TR <br /> 6514 Rippling Brook Dr Se,Salem,OR 97317 082W03B 02100-Primary <br /> Address: 6514 RIPPLING BROOK DR <br /> SE <br /> _ SALEM OR 97317 <br /> ,..�i�`� .,�.� ���,.�s's„� ... <.�....4 ,,� i.,IGENSU PROPES52`ONAi.,INl=ORMATtONf FPk a511;' '0101 <br /> Business Name License Address Phone <br /> ACE SEPTIC&EXCAVATING,INC. Installer/Pu 33013 PO BOX 9177 BROOKS OR 97305 503-393-1033 <br /> mper <br /> License <br /> Fee Description Quantity Amount <br /> Repair(minor) -single family dwelling 1.00 Ea $305.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $405.00 <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:a6/09/2023 1 std_BuildingApplication pr <br />