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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 /> O RE G: O.N <br /> 555-22-010037-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 /> wt S,';, '. r, a v ,_ .v.'. _,:._ TypE,OWORK ..v <br /> No Code Edition Specified <br /> Type of Work: Category of Construction: <br /> None specified Single Family Dwelling $0.00 <br /> Description of Work: NSFD 3 BDRM <br /> Property Address: Parcel: Owner: BUSBY,ORVILLE R&BUSBY, <br /> 6753 Shaw Hwy Se,Aumsville, OR 97325 082W24 01100-Primary JANET D <br /> ` Address: PO BOX 266 <br /> AUMSVILLE OR 97325 <br /> 3 A 3 . . . 4N1 TCEN5 0 PRO*ESS CANAL INF'd*ATION :..,�,, ,., . . , a <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 /> Fee Description Quantity Amount <br /> Install-Standard subsurface -b allons er da GPD 1 010.00 <br /> Y 9 P Y 450.00 $ , <br /> DEQ Surcharge 1.00 Automatic $100.00 <br /> Total Fees: $1,110.00 <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:11/02/2022 1 std_BuildingApplication pr <br />