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Marion County Building Inspection <br /> 555 Court St.N.E.,Room 2260,-PO Boz 14-500-Sa1em,Oregon 97309-5036 - -- <br /> Office Hours: 8:00-4:30 Phone: (503)588-5147 -Inspection Line (503)373-4427 <br /> Check your Permit Status On Line at:http://publicworks.co.marion.or.us/building/ <br /> SEPTIC APPLICATION <br /> DATE: 03-02-2007 TYPE: SE ACTIVITY NO: 07-01503 <br /> OFFICE: MC USE: R STATUS: APPLIED <br /> MAP: 67 SITE: GS APPLIED: 03/02/2007 <br /> ZONE: AR EXPIRES: 08/29/2007 <br /> DESC: SE: PROPOSED SUBDIVISION LOT 2 OF 4 <br /> SITE ADDRESS: 954 CAMELOT DR S SL <br /> PARCEL: 093W04D 01700 <br /> APPLICANT: ALMENDINGER,DAVID & LINDA PHONE: 503-743-3256 <br /> ADDRESS: 6316 NICKLAUS LP N <br /> KEIZER OR 97303 <br /> OWNER: ALMENDINGER,DAVID & LINDA PHONE: 503-743-3256 <br /> ADDRESS: 6316 NICKLAUS LP N <br /> KEIZER OR 97303 <br /> OCCUPANT: <br /> INSTALLER: PHONE: <br /> LICENSE NO: <br /> ADDRESS: <br /> Existing Bedrooms: 0 Proposed Bedrooms: 4 Total Bedrooms: 4 <br /> Existing Employees: 0 Proposed Employees: 0 Total Empl.: 0 <br /> Existing Seating: 0 Proposed Seating: 0 Total Seating: 0 <br /> Description Fee Units Description Fee <br /> Site Evaluation $400.00 Authorization with FV $0.00 <br /> Rural Area Variance $0.00 Authorization without FV $0.00 <br /> New Installation $0.00 Auth/MajRep $0.00 <br /> Major Alteration $0.00 Auth/MinRep $0.00 <br /> Minor Alteration $0.00 Auth/MajAlt $0.00 <br /> Major Repair $0.00 Auth/MinAlt $0.00 <br /> Minor Repair $0.00 Record Review $0.00 <br /> Permit Renewal with FV $0.00 # Trucks, Pumper Inspec $0.00 <br /> Permit Renewal without FV $0.00 # Pumps, Dosing Siphon $0.00 <br /> Plan Review $0.00 # Other Inspection Hrs $0.00 <br /> Misc/Copy Fee $0.00 # Reinspection Hrs $0.00 <br /> Other Septic Fee $0.00 DEQ Surcharge $40.00 <br /> Annual Eval Altern System $0.00 Refund Code $0.00 <br /> Existing System Eval $0.00 <br /> Total Assessed-Fees: - $440.00 <br /> Adjustments: $0.00 <br /> Total Fees: $440.00 <br /> Total Payments: $440.00 <br /> Balance Due: $0.00 <br /> THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE SOIL, FEASIBILITY, AND <br /> INSTALLATION REQUIREMENTS ARE CHECKED PRIOR TO THE ISSUANCE OF A PERMIT. IT IS THE RESPONSIBILITY OF THE <br /> APPLICANT TO ASSURE THAT ALL NECESSARY INFORMATION IS PROVIDED. AS SOON AS ALL REQUIREMENTS OF THE REVIEW HAVE <br /> BEEN MET, YOU WILL BE NOTIFIED. THIS APPLICATION EXPIRES IN 180 DAYS. <br /> THE "ORANGE CARD" MUST BE POSTED AT THE COUNTY ROAD NEAR THE DRIVEWAY TO THE PROPERTY TO ASSIST STAFF IN <br /> LOCATING THE PROPERTY. <br /> BY MY SIGNATURE, I CERTIFY THAT THE INFORMATION I HAVE FURNISHED IS CORRECT, AND HERBY GRANT MARION COUNTY, <br /> AUTHORIZED AGENT OF THE DEPARTMENT OF ENVIRONMENTAL QUALITY PERMISSION TO ENTER ONTO THE ABOVE DESCRIBED <br /> PROPERTY FOR THE SOLE PURPOSE OF THIS APPLICATION. <br /> SIGNATURE OF APPLICANT: XQ • <br /> WARREN D.JACKSON,MARION COUNTY BUILDING OFFICIAL%BY PB _ <br /> CALL BEFORE YOU DIG...ITS THE LAW. <br /> ATTENTION:Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.Those rules are set forth by Oregon Administrative Rules.You may obtain copies of the rules by calling the center. , <br /> (Note:The telephone number for the Oregon Utility Notification Center is 1-800-332-2344). <br /> l <br />