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t / Marion County Building Inspection 555 Court St.N.E.,Room 2260,PO Box 14500 Salem,Oregon 97309-5036 Office Hours: 8:00-4:30 Phone:(503)588-5147 Inspection Line:(503)373-4427 SEPTIC APPLICATION DATE: 07-21-2005 TYPE: SE ACTIVITY NO: 05-05214 OFFICE: MC USE: R STATUS: APPLIED MAP: 68 APPLIED: 07/21/2005 SITE: GS EXPIRES: 01/17/2006 ZONE: AR EFU DESC: SE: 2 a SITE ADDRESS: 2408 SE FARMER RD JF PARCEL: 093W23A 01600 APPLICANT: KENT,PETER R & ADDRESS: KENT,PATRICIA A 2388 FARMER RD SE JEFFERSON OR 97352-9609 97352-9609 PHONE: 503-316-8898 OWNER: KENT,PETER R & ADDRESS: KENT,PATRICIA A 2388 FARMER RD SE JEFFERSON OR 97352-9609 PHONE: OCCUPANT: KENT,PETER R & INSTALLER: LICENSE NO: ADDRESS: PHONE: Existing Bedrooms: 0 Proposed Bedrooms: 2 Total Bedrooms: 2 Existing Employees: 0 Proposed Employees: 0 Total Empl.: 0 Existing Seating: 0 Proposed Seating: 0 Total Seating: 0 Description Fee Units Description Fee Site Evaluation $400.00 Authorization with FV $0.00 Rural Area Variance $0.00 Authorization without FV $0.00 New Installation $0.00 Auth/MajRep $0.00 Major Alteration $0.00 Auth/MinRep $0.00 Minor Alteration $0.00 Auth/MajAlt $0.00 Major Repair $0.00 Auth/MinAlt $0.00 Minor Repair $0.00 Record Review $0.00 Permit Renewal with FV $0.00 # Trucks, Pumper Inspec $0.00 Permit Renewal without FV $0.00 # Pumps, Dosing Siphon $0.00 Plan Review $0.00 # Other Inspection Hrs $0.00 Misc/Copy Fee $0.00 # Reinspection Hrs $0.00 Other Septic Fee $0.00 DEQ Surcharge $40.00 Annual Eval Altern System $0.00 Refund Code $0.00 Existing System Eval $0.00 Total Assessed Fees: $440.00 Adjustments: $0.00 Total Fees: $440.00 Total Payments: $440.00 Balance Due: $0.00 THIS IS NOT A PHT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE SOIL, FEASIBILITY, AND INSTALLATION REQUIREMENTS ARE CHECKED PRIOR TO THE ISSUANCE OF A PERMIT. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT ALL NECESSARY INFORMATION IS PROVIDED. AS SOON AS ALL REQUIREMENTS OF THE REVIEW HAVE BEEN MET, YOU WILL BE NOTIFIED. THIS APPLICATION EXPIRES IN 180 DAYS. THE "ORANGE CARD" MUST BE STED HE CO Y R NEAR THE DRIVEWAY TO THE PROPERTY TO ASSIST STAFF IN LOCATING THE PROPERTY. SIGNATURE OF APPLICANT: X t WARREN D.JACKSON,MARION COUNTY BUILDING OFFICIAL/BY RSFSSUMS CALL BEFORE YOU DIG..ITS THE LAW. ATTENTION:Oregon law requires you to follow mks adopted by the Oregon Utility Notification Center.Those odes are set forth by Oregon Administrative Rules.You may obtain copies of odes by calling the center. (Note.The telephone number for the Oregon Utility Notification Center is 1-800-332-2344).