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ReCeived By: / v'q~r .... Sdib~m, OR 97301 U L~ <br />Zoning x)~i~ _)~on:~ 8:00 am. 4:30 pm Phoue 588-5147 ~1- <br /> SI~ EVALUATION ~D/OR SE~IC PE~ APPLICA~lNG INSPECTI~N., <br /> <br />Commercial (DSC-Daily Sewage Flow) <br />SiteEwtlua~onwfir~t 1000 gaL DSF" -- $ 2(~.00 520,00 $~ <br />Site Eva,[uatJon, ea. ~dl. 5~ gal, ~F 60,~ 20,~/AI <br />Staad~d System m~e than 1~ gal, DSF: <br />$~,~ + $I $/each addL 5~ gal, DSF 10.~ <br />Capping Fill 330.~ 10.~ .... <br />D~sal Tm. d~es, n,~prol m 2~.~ 10,~ .... <br />Gray Water W~st¢ Di~eal Sut~ 95.~ 10,~ <br />Holding Tank 2~.~ <br />Press~ Distfibutlo~ 280.~ 10.~ <br />Re&~.nda~t System ..... 2~.~ 10.~ <br />Sand Filter 355.~ <br />Seepage Trench ......... 2~,~ 10.~ ....... <br />~1~ ~wa~erins'S~t~h 280.~ 10,~ <br />Plan Review <br />600 gal,,DSE I~l gfl. DSF .... 80-~ .~,, <br />(exy~t SAND FIIH'ERS) <br />For each z~ditiomal 5~ g~. DSF 20.~ .~ ........ <br />Alterations 2~.~ 10.~ <br />Repfir~nor ....... ~.~ 10.~ <br />Constme0on Permit Renewal O:ield Vi~ts) 120.~ 10,~ <br />Construction Perxxfit Renewal (No Field Visic~) 70,~ 10.~ <br />Exisfin~X[~ Evaluation Re~ 120.~ 10.~ <br />Au~ori~fion Nmice ffield Vifit ) ........ 120.~ 10.~ <br />Audmri~fion N~iq* ,(~fJ21a Visit) ,7~:~ 10-~ <br />Anneal gvaluafion o~e ~yj~ 75.~ 1,~,:~ <br />Pum~r ~lck i~l~jon, First ~ck 50.~ ,(D <br />i um ~r Track In ~ecfion, ea. i~dl, <br /> <br />(Miak if Applicable to ibis Application) <br />('.~e4.Test l-Iole~ ~e Dug <br /> <br />) I am perfornfing work on a property I own or occupy <br />) i a~l a registered builder or ( ) tile authorB'~d rcpre~entafive <br />of a registered builder. <br />) Thc work will be performed by a DEQ Licensed h~staller <br />) Od~er <br />) I agree to install according to tile submitted plans and <br />specifications, tile laws of Ihe State of Oregon and the <br />ordinances of Marion County, <br /> <br />Phone No, <br /> <br />Phone No. 'g~--p~'"~ r7 g ~7 <br /> <br />Residential Sin$l* Family <br />Site Evaluation, first lot $ 200,00 $20,0~ $ <br />Site Evaluation, e~, eddl. lot l~ff30 20.00 <br />Construction permit <br /> 2~.00 <br />Standard Sy,stem ........ <br /> 330.00 10.00 <br />Capping Fill <br />Disposal Trench in Saptolile 200.00 I 0.00 <br />Gray Water Disposal Sump 93.00 iO,O0 ....... <br />Iloldiug Tan~ .... '"' 200.00 10.00 <br />Pressure Dislfibufion 280.00 ' "'10~00 <br />Sand Fil~r 355,0(] 10.00 <br />S~epage Trench "' 200.130 10700 <br />R~puir, Major (drY'infield) ..... 95JX 1~6.00 ..... <br />Consml¢lio~ permit Renewui (Field Visi!! ..... 126.-00 10.00 <br />Construcfion"Permi~ Renewal (No Field Visit) 70,0(]' 10,(XI <br />Relnspec3!on Fee 25.00 .00' <br /> <br />Aulhodvation Nofie~ (No fi*ld vlsJt) ...... 70.00 i0.00 <br /> <br />Annual ~valuafion/ARernative System 1261'00 .~,00 <br /> <br />An,nual Evaluation/Temp. or Hards¢ip,,MH 75,,,_O0,~ .00 <br /> <br />eage print): <br /> <br />DATE: <br /> <br />MC ]5-74 REV 1/92 <br /> <br /> <br />