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MARION COUNTY <br /> Building Application 5155 Silverton Rd NE <br /> Marion Salem,OR 97305 <br /> county 503-588-5147 <br /> Permit NA FAX: 503-588-7948 <br /> 0.11..E G O.N' <br /> 555-23-006795-PRMT <br /> www.co.marion.or.us building@co.marion.or.us <br /> Applicant: Lone Pine Corner Septics Inc. <br /> 8778 Cascade Hiahway. NE <br /> Silverton, OR 97381 <br /> €k' X�E°t• q; ''j ..-- �. h �AN'�M.. iP •ar. °hw <ny <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: NEW INSTALL FOR FUTURE 4BDRM SFD <br /> a <br /> Property Address: Parcel: Owner: DIAMOND SPRING RANCH <br /> 6736 Joseph St Se,Salem,OR 97317 082W10C 01400-Primary LLC <br /> Address: 5125 WITTENBERG LN NE <br /> KEIZER OR 97303 <br /> t .ti h ek a NS1 3t PROFESS it L N O ATT+' . Witt <br /> Business Name License Address Phone <br /> LONE PINE CORNER SEPTICS INC. Installer 37003 8778 CASCADE HIGHWAY,NE SILVERTON 503-873-7157 <br /> License OR 97381 <br /> gti. Pommy , r .. ;ERl!� FIBS <a iffilC <br /> Fee Description Quantity Amount <br /> Install-Standard subsurface -by gallons per day 450.00 GPO $1,050.00 <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $1,150.00 <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:0e/0e/2023 1 std_BuildingApplication pr <br />