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'CITY USE ONLY MARION COUNTY BUILDING INSPECTI sgE avI <br /> COMMUNITY DEVELOPMENT CENTER Reoekled By: 41)p4 0/1.e,✓ 285 Chinch St.NE -Room 132 elk <br /> 1k <br /> • <br /> Salem,Oregon 97301 • <br /> Zoning Validation: eolt 8:ooam-4:3opm Phone 588-5147 J U N - 2 1997 <br /> Date: T•-„a'!41 c 1•G4051 24 hr.Inspection Line 588-7904 , <br /> FAX 588-7940 i i i' !N COUNTY <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLI: �Is• INSPECTION <br /> 1.LOCATION OF INSTALLATION -` /�y�� (� %�� <br /> Pmpeny owner\JA M' •i�� 4 DN tee;/' /Ja/ ejv Phone xo. O�7 /-1� <br /> lob Addrcas Lcb io J/4hrii etrYt, t #1_3 Tax Acct.No. 1 O so..r 2D oaa Cc Sdeet <br /> 15 or q/31L4 .. / `� . Use of Sauce=rntd k/I '444. <br /> Subdivision Lot co 9j) Block No.Employees <br /> Existing No. Proposed No. <br /> Bedrooms Bedrooms <br /> Section „--7 Township ;5r7 � 3 E. zone/1 /,��,�, MaPPavato We l ( ) SP�z ( )Lot Width s• Lot Depth IAcres 1 i�,• trreg.Lot Corner Comffimity Welt ( ) City 92.CONTRAC OR INFO RMAATTI - . <br /> Pmperiyowner •�/OR - Mailing Address • <br /> Phone No. • <br /> Amtr.AgentLamee . MeitiggAddrea Phone No <br /> Contactor Buthneae Name&Number Mailing Address Phone No. <br /> 3.FEES . <br /> "Fees include DRQ Surcharge(S30.00). S <br /> Site Evaluation,Single Family Dwelling,first lot .5320.00 ' <br /> Site Evaluation,Single Family Dwelling,ea addl lot 235.00 <br /> Site Evaluation,Commercial,first 1000 gallons 320.00 . <br /> Site Evaluation,Commercial 1000-5000 gallons 320.00+$90/500/gel +5100/500 gallons <br /> Site Evaluation,Rural Area Variance 320.00 <br /> Construction Permit or Commercial Major Repair,first 1000 gallons: <br /> Standard System. 382.00 <br /> Aerobic System 218.00 • <br /> Capping Fill System 593.00 <br /> Cesspool 382.00 <br /> Disposal Trench in Seprolite • 382.00 <br /> Evapotranspiration-Absorption System ... 218.00 • <br /> . Gray Water Disposal Sump • 190.00 <br /> Pressure Distribution System 553.00 <br /> Redundant System 382.00 <br /> Sand Filter System • 703.00 • <br /> • •Seepage Pit 312.00 <br /> Seepage Trench " 382.00 <br /> Steep Slope. 382.00 <br /> rile Dewatering System .550.00 <br /> Construction Permit or Commercial Major Repair,over 1000 gallons: , <br /> Construction Permit Fee +$25/500 gallons <br /> Commercial Plan Review <br /> 600 gallons-1000 gallons 133.00 <br /> • 1000 gallons-2500 gallons _ 133.00,.•+,S25/500 gallons . <br /> Commercial Minor Rape' <br /> Single Family Dwelling,Minor Repair(tank only) 130,00 <br /> Single Family Dwelling,Major Repair(dtainfield) 210.00 <br /> Residential or Commercial: <br /> Alterations 378.00 <br /> 'Permit Renewal,Field Visit • 227.00 <br /> Permit Renewal,No Field Visit _ 115.00 <br /> Authorization,Field Visit 247.00 <br /> Authorization,No Field Visit 117.00 <br /> Existing System Evaluation 247.00 <br /> Annual Evaluation/Alternative System. 247.00 • <br /> Annual Evaluation Temporary/Hardship Mobile Home 183.00 <br /> Annual Evaluation,Large System 123.00 <br /> •Pump or Dosing Siphon .25.00 <br /> Pumper Truck Inspection,First Vehicle 67.00 - <br /> Pumper Truck Inspection,Ea Additional Vehicle 40.00 - <br /> Septic Reinspection Fee .25.00 - <br /> Septic Inspection for which no fee is specifically indicated 40.00/hr • <br /> • <br /> • {{yy���//���A1Jo <br /> Receipt Total: 1"�,4r <br /> Name of Applicant(Please • ): 414 <br /> Q(1�Ei // V IAS Test Holes heady: <br /> n 7 Do, <br /> Signature of Applicant Date: -7 K Tank Pumped: • <br /> Data <br /> MC 15-St Rcv 8/95 Pumping Certification Attached:(Y) (N) <br />