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FOR OFFICE USE ONLY
<br />Received By ,"~14~4-~
<br />Zomng VahCafion ..ff~.C.~
<br />Date:: DJ,~/ f2~-</q3
<br />
<br />M~RION COUNTY BUILDING INSPECTION
<br /> 220 High Steer NE
<br /> Salen~ OR 97301
<br />
<br />8;00 ~m.-4:30 pm Phon¢ 558-5147
<br />Code-A-Phone 588-7904
<br /> FAX S$8-7948
<br />
<br />MARION
<br />
<br /> BUILDING INSP~,CllON
<br />SITE E¥/kLUAT[ON ,adklg/OR SEI:'TIC PERMIT APPLI( ~TION
<br />
<br />T~ Acct, No,~ ~ j~O
<br /> U~ of St~cmm
<br />Block ~ "No.
<br />
<br />lation
<br />
<br />Auth, Agen~l~a~e 0 ~ Mailing Address- Phone No,,
<br />~nt~.~tor BuSiness N~ & Numb~ ' , ~ .... ill Add s:: ' , Phone No '"
<br />
<br /> Site Evaluatioa~ ti~[ ,1,0,00 8al, DSF ~,{$,00 20~00
<br /> S~ada~"~yste~ less than 1000 SM, DSF' 245,00 10,00
<br /> Smnda~ System mo~ than 1000 ~al. DSF: ,
<br /> 5245,,00,~,,$15 each ~dl. 500 gal. DSF ...... 1000
<br /> Cappin8 Fill 41500 10,,00
<br /> ~ispo~l T~nchos .... in S~pmli~ 245.00 10.00
<br /> Holdin8 T?nk ..... 245.00 10.00
<br /> Redundant System ........ 245-00 1,,q,.90
<br /> ~epa~* l~nch ......... 24~00 1000
<br /> Steep Slop~ ..... 245,,00
<br /> >6o0 ~,l. mF, ki06i"kon m~ ...... ~0o.o0 .00
<br />
<br /> Alterations ,~45,,90 .......... 10.00
<br />
<br /> Conslme6o~ Pe~it ,Rg,~,~l (No Field Visits) ~5,00 10.00
<br /> ~ s n~System ~wluafion ~po~ 15~.00 10.~ .....
<br /> Authofizmtlon Notice (Field Visd) 150,00 10-00
<br /> Authofi~tlon Notic~ ~o Fidd,~,~g' ,, 85,00 10,0O
<br /> Annual Evaluation of Al~mativ~ System 150,00 10,,O0
<br />
<br />,,~mpet T~ck Inspe*tion, Fi~ttmck , 59,~q ....... .0q.
<br /> ~,~per Track Insp~tion,~a, ~dL tm~k 35.00 .00 /
<br /> ~h~r
<br />
<br /> Residential Sin ~e~._~v
<br /> Site Cvaluatiog~,.~rst lot 24500 2000 ~.~
<br /> Site Evaluation, es, acldl, lot 20500 20.00
<br />
<br /> Standard System 24,5 Q0 .......... .1000
<br /> ~anvin~ Fill 41 ~ 00 10,00
<br /> Di~>~$al Trench i~ Sal~rolit~ 245.00 10,00
<br /> Gray Waler Disposal Sump .,,[~0.00 10,,00
<br /> Holding Tank 24500 I0.00
<br /> ,p,ressum Disthbu0on ~50.00 1000
<br /> Redundant 245.00 1000
<br />
<br />....Sand Filter 44300 1000
<br />Seepage Trench 24500 1000
<br />Steep Slope 245,00 10-00
<br /> Tile Dewatefing 350,00 I000
<br /> Alteration 245,00 , 19;,09 ...........
<br /> Repair, Major (draiafield) 11500 1000
<br /> Repair. [Minor (lank) 5'500 1000
<br /> Construction Permit Renewal (Field Visit) 15000 1000
<br /> R~insp¢ction Fee 2500 O0
<br /> AuthofiT~ioi~ Notice (Field Visit) 1~000 IO.00
<br /> Authofiz~ation Notice (No Field Visit) 85.00 10,00
<br /> Existing System E~ aluation 150,00 1000
<br /> Annual Evaluation/Alte restive System 15000 00
<br /> Annual ~vMuMio~VTemp of HaedshJp MH 9000 00
<br /> Rural Area yafianee Site Evaluation 24500 2000
<br />
<br />Receipt No
<br />
<br />(Mark if Appheabl~ to this Application)
<br />
<br />( ) I am peffo~ing work on ~ pmp~y I own or o~cupy~ ~ x ~ N~E OF APPLIC~T (please print):
<br />( )Iamaregistemdbuilderot( )lheauthodzeO~e
<br />
<br />( Other ~
<br />
<br />of the Slate of Oregon and the ordinan¢¢s of Marion Counly
<br />
<br />DATE:
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