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OFF. ICE USE ONLY
<br />
<br />[Zoning ValidatiOl~~ I
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />~ 220 High Street NE
<br /> Salem, OR 97301
<br />
<br /> g:00 am - 4:30 pm Phone 588-5147
<br /> Code-A-Phon~ 588-7904
<br /> FAX 588-7948
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br /> 1. Location of Installation , ,
<br />
<br /> 2. Contractor lnbrmation
<br />
<br />C~'n~ Bu~s~ & Nmn~ M~ n~ Address Phone No.
<br />/ DEQ IJcenaed Contr~t~ & No. I MMB*gAa&ess: Iph°ne "°''
<br />
<br /> Commercial (DSF-Daily Sewage Flow)
<br /> SlteEval.auon, fir~ 1.0~gal:DSF $ 200.00 ~120.00 $
<br /> Site £vaiuation ea. addl. 51~0 $~1. DSF 60.00 gO.OO/n
<br /> Construction & Repair Permitz
<br /> Standard System le$~ than iO00, g.al_~IDSE ; 200.00 '1'0.00
<br /> Standard System more than 1000 gal. DSF:
<br /> $200~00 + $1~/each addl. 500 ~;k'~DS F ......... "i'O,00
<br /> Capping Fill 330.00 10.00
<br /> Disposal Trond~o$ ia Saprofite ...... 200,00 10.00
<br /> Gra[,Water Waste Dizposal Sump .......... 95-00 10.00 ......
<br /> Holding Tank 200.00 I0.00
<br /> Pre~u~ Divttiblttioh .... 2~0~00 10.00
<br /> g*dundant System 200.00 10~00
<br /> Sand Filter 355~00 10,iN)
<br /> Seepage Trench ...... 200.00 10~00 ,
<br /> Staep Slope 200.00 I0.00
<br /> Tile Dewatering System 280.00 10.00
<br /> Plan Review
<br /> 600 gal. DSF, 1001 '~ai, DS~F 80,00
<br /> (except SAND FILTER~,! .......
<br />For each additional 500 gal. DSF 20,00
<br />"~lterafion~ .... 200,00 10.00
<br />~l[¢pair,Minor ........ 60.~ 10,00
<br />Construction p~mfi~ Renewai (Field Visil,q) 120.00 10:0~
<br />Cons~ucfion Pemfit Renewal (N~,,F,!,.~hl~Vi~j~s) ?0.(X) 10.00
<br />Existing System Evaluation Repo~ 120.00 10.00
<br />,,.A. udlori?,ation Notice (Field Visit) 120,00 10,00
<br />Authorization Notice (No Field Visit) 70.00 I0.00
<br />AntmalEvah~ati,~ono~AlmrnadveSy~tem 120.00 10,00 ,,-
<br />Annual F~valuation of Larse STstem ........ 75.O3 10.00
<br />Pumper 'lYuck Inspection, Fi[y,!,,.truck 50.00 .00
<br />Pumper 'l~m,k, ,I~qe~ctlo~! ea- addl. Imck 35,00 .00 ..........
<br />Othe~
<br />
<br /> Re~'i~;ntiai Single Famny .......
<br /> $ 200.00 $20.00 $
<br /> S e Evaluation~ first 1o~ ........
<br /> Site Eyaluatlon, ea. addl, lot ...... 165,00 20,00
<br />
<br /> Standar,i System .... "" , ....... 200:~0 10,00
<br /> Capping Fill .,~ 330.00 I0,00
<br />
<br /> Disposal Trench in Saprollte 200.1XI '""] 0.00
<br /> 95.00 10.(g)
<br /> Gray Water Disposal Sump .....
<br /> Holding'D. nk ...... 200,00 1010~' . ....
<br />
<br /> Redundant 200.(~ 10.00
<br /> Sand l~i'lter ..... 355,0~ 10.00
<br /> Seepage Trench .....
<br /> Tile Deyatering 280,0~ 10,00
<br />
<br /> Repair, Majo~,(d~tmelti) ...... ~,0C 10,0~
<br /> Repair, Minor (tank) 60,~ 10,fr0
<br />Con~U'uctloa permit Renewal (Field Visi~i '" ,,-- 120,0(: 10,00
<br />~Constmction Permit Renewal (No Fi~l.d' Visit) 70.~ l 0,00
<br /> Rei~pection F~,~, 25.0C .00
<br /> Aufl,otizafion Notice (Field Visit) 120,0C 10,00
<br /> AuflxorizaOon Notice (No field visit) 70.0~ 10.00
<br />
<br /> Annual Evaluation/l'emA~. or Flardship M}I 75,00. ,,, .00
<br />
<br />(Mark if Applicable to this Application) ) Test Holes are Dug
<br /> ) 1 will call when Test llale~ Dug
<br />
<br />! I am peffoenting work on a property I own or occupy
<br />) I am a registered btfild~t of ( ) the authorized representative
<br /> of a registered builder
<br />) The work will bt3 performed by a DEQ Licensed Irataller
<br />} Olher
<br />) I agree to in~tall according to tim sublltitt e,d plans and
<br /> specifications, 0~e laws of the State of Oregon and the
<br /> orddianee,~ of Marion County,
<br />
<br />MC? 15-74 R~V 1/92
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<br />Total
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