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FOR OFFICE USE ONLY
<br />R~ceived By:
<br />Zoning Validation
<br />Date:
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br /> 22~ Hish ~h~et NB
<br /> Salcng OR. 97301
<br />
<br />8:00 a.m.-4:30 pmPhoae 588-5147
<br />Code-A.Phoae 588-7904
<br />FAX585-7945
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1. Location of Installation
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<br />JobAddm~s ~ ~m ~. ~O~,'~ ~~ T~Acct, No,/~~ CwssSt~et ~ ~~ ~
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<br />Subdivision ~-~~ ~t 1~ Block ~ ~mvl0vees ~ ~
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<br />2. Contractor Info marion : b~ ,5~,a¢4~¥~O ~
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<br />Fees
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<br />Comm~cial (DSF ~ Dailv
<br />Site Ewduatlon~ tint 1000 ~1, DSF ......... ~,~.0~ 20,00
<br />Con~tmctiov & ~pair Pe~its.-.-~---:
<br />Smnda~ Sys~m ~cs~ ~n !000 ~[ D~'~ ~ 24~,00 10,00
<br />Smnda~ Sys~m mo~ th~: q~ -O~-
<br />g24~,00 + ~15 ~ach addl, 500 ~1, DSF .~1 ~ 10.00
<br />~ppin$ Fill 415,00 10,00
<br />Dispo~l Tmnch~s in ~pmli~ "~5.00 10.00
<br />Gray Water Waste Di~o~l Sump ..... 120,00 I0.00 "'/
<br />Holding Tank 245,00
<br />P~ssum Distfibutlon 350200
<br />Redundant Sys~m ~5-00 10,00
<br />Sand Filer 44~.00 ~ 10,00
<br />~epage T~neh 245.00 10,00
<br />Tlh Dewa~ofing Sys~m $f0,00 10.00
<br />plan ~view
<br />(~or gash ~ditiona1500 gal DSF 25.00 ..... ,~
<br />Conslmctioa Pomit Renewal ~o~igl~,,,ylsi~) 85.00 10.00
<br />~isting Syg~,~, Evaluation ~poR 150.00 10.00
<br />Autbo~t[0n NotiCe ~o Field Visit) 85,00 10,00
<br />Annual Evaluation of AIt*m~i,w Sys~m 150,00 1,9:00
<br />Annual Evaluation of La~* System 90.00 10.00
<br />~mp~r Track Inspection~ Fi~,[~ck 50.00 .00
<br />~mper Track la~q~,ion. ~g ~d tmok 35,00 ..... -00
<br />
<br /> Residential giltgl,f~.~.~m ii¥
<br /> Site ]Sv*luation, fi..rs,~.,lo,t, , , ; 245.00
<br /> 00
<br /> Site Evaluate,RS~,~,a, ~dL lot ] 20~.00 20.00
<br /> Holding Tank 2~S,00 10,00
<br /> P~ssu~ Di~n~utioa 350,00 10.00
<br /> Redundant 2a5,00 10.00
<br /> Sand Filer 7" 445,00 10,00
<br /> ~cpagc Tgn~h 245.00 10.00
<br /> Steep Slope 245.00 10,00
<br />
<br /> Altc~oa ........ 245.00
<br />Re~air, ~jOr (dmin~eld) · ,,,~,[~5.00 10,00
<br />~pair, Minor (~k) 75,00 10.00
<br />~nstmetlon ~} ~n~l {Field Visit) 150,00 .... 10.00
<br />~ngtmction ~emlt ~9~,~al ~o F e dV s t} 85,00 I~.00 ,,
<br />Authomtion Notlce {Fiel~,,,~isit) 150,00
<br />,,,,Authofi~t on No ce (No F e d V s !),, 85.00 10,00
<br />~isting $ystem'Evaluatlon 150-00 10.00
<br />Annual Evaluatio~Al~gtive System 150.00 ,00
<br />Annual E~aluaio~emp, or Ha~ship MH 90.00 -00
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<br />(Mark if Applie~abk to this Appllcatlol0
<br />( */fTc st H~>les are Dug
<br /> ) I will call when Test Hol~s DuB
<br />
<br />) I am performing work on a propc~t7 1 own or occupy
<br />)Iamaregisteredbuilderot( )theauthori~dmpmscntetive'
<br />) 7~e work will be peffo~ed by a DEQ Lk~nsed lns~ller
<br />) Other
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<br />MC 15-SI REV 2/93
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