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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
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