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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Salem,OR 97305 <br /> • ° <br /> ,Mario,{4v7.. 503-588-5147 <br /> Authorization NA <br /> FAX: 503-588-7948 <br /> OREGON <br /> 555-21-010181-AUTH <br /> www.co.marion.or.us building@co.marion.or.us <br /> • <br /> • <br /> x •° ° <br /> ° <br /> •..... .. .,. a ... <br /> Applicant: Lone Pine Corner Septics Inc. <br /> 8778 Cascade Hiahway. NE <br /> Silverton, OR 97381 <br /> • V .TYPE OF WORK <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified None specified $0.00 <br /> Description of Work: FIRE-AUTH 2 BDRM SFD to REPL 2 BDRM <br /> „ ,,'' 0:01$YTE INFORMATIO <br /> Property Address: Parcel: Owner: EGGERT,JONATHAN A <br /> 9565 Elkhorn Woods Cir Se, Lyons, OR 97358 093E02DD00500- Primary <br /> Address: 7858 KATHERINE ST NE <br /> KEIZER 9,7303 <br /> _i '".,I,IGENSED pR"OFESS i)NAL INFO,kmATgCIN aE_ - • <br /> ._... _. <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 /> 6 1 PERMIT' FEES; • ; I <br /> Fee Description Quantity Amount <br /> Authorization notice-with field visit 1.00 Ea $450.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $550.00 <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:10/08/2021 • 1 std_BuildingApplication_pr <br />