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Marion County Building Inspection 5155 Silverton Rd NE-PO Box 14500-Salem,Oregon 97309 Phone:(503)588-5147 Inspection Line: (503)373-4427 Check your Permit Status On Line at: http://publicworks.co.marion.or.us/building/ SEPTIC APPLICATION DATE: 11-07-2012 TYPE: NEW ACTIVITY NO: 12-06306 OFFICE: MC USE: C STATUS: APPLLS.D MAP: 99 SITE: G APPLIED: 11/07/2012 ZONE: C TC EXPIRES: 05/08/2013 DESC: NEW INST: SEN 10-03718 TINTO FISH FACILITY 6 1 EMPLOYEE SITE ADDRESS: 34939 NORTH SANTIAM H'Y SE GT PARCEL: 094E29 00600 APPLICANT: A AFFORDABLE SEPTIC SERVICES LLC PHONE: 503-682-1929 RICK ADDRESS: PO BOX ".:30 WILSCNVILLE, OR 97070 OWNER: UNITED STATES CF AMERICA PHONE: ADDRESS: C/O ARMY CORPS OF ENGINEERS PO BOX 3755 SEATTLE WA 98124 OCCUPANT: INSTALLER: A AFFORDABLE SEPTIC/RICK JONPS PHONE: 503-682-192G LICENSE NO: 37918 ADDRESS: PO BOX 1130 WILSONVILLE OR 97070 Existing Bedrooms: 0 Proposed Bedrooms: 0 Total Bedrooms: 0 existing Employees: 0 Proposed Employees: 1 Total Empl.: 1 Existing Seatinm 0 Proposed Seating: 0 Total Seating: 0 Description Fee Units Description Fee Site Evaluation S0.00 Authorization with FV $0.00 Rural Area Variance $0.00 Authorization without FV $0.00 New Installation $652.00 Auth/MajReo $0.00 Major Alteration $0.00 Auth/MinRep $0.00 Minor Alteration 50.00 Auth/MajAlt $0.00 Major Repair 50.00 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 DEQ Surcharge $E0.00 Mise/Copy Fee $0.00 Refund Code $0.00 Other Septic Fee $0.00 ATT Insp Fee/No Report $0.00 Total Fees: $72.00 Existing System Eval $0.00 Total Payments: $712.00 Balance Due: $0,00 THIS IS NOT A PERMIT. 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 CF 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 POSTED AT THE COUNTY ROAD NEAR THE DRIVEWAY TO THE PROPERTY TO ASSIST STAFF IN LOCATING THE PROPERTY. BY MY SIGNATURE, I CERTIFY THAT THE INFORMATION I HAVE FURNISHED IS CCRRECT, AND HERBY GRANT MARION COUNTY, AUTHORIZED AGENT OF THE DEPARTMENT CF ENVIRONMENTAL QUALITY PERMISSION TO ENTER ONTO THE ABOVE DESCRIBED PROPERTY FOR THE SOLE PURPO 7 bf T. SIGNATURE OF APPLICANT: X I . WARREN D JACKSON,MARION COUNTY Bell DING OFFICIAL,BY COI/FEIN C V I.BEFORE YOU DIG.ITS TNT LAW ATTENTION.Oregon law requires you to follow rules adopted be the Oregon I1i1ey Notification Center those rules are set gosh by Oregon Adnu calmative Rules You may obtain copies of the roles by calling the newer. (Note:The telephone number for the Oregon Utility Notification Center is I.g00-3=434,1)