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Received By.'~. ~ 220 High Street WE l, lkl '! "i
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<br /> SITE EVALUATION ~/OR SEPTIC PE~IT ~PLICATION
<br />1. Location of Installation ~Ot 8 ~ g ~,,,~ ~, g'
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<br />DEq
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<br />ComGK~c~al COSF - Daily Sewm,e Flow)
<br />Site Evaluation, es, addL 500 Sal,, D~?, 75.00 20,00/m
<br />¢o0struction & Repair pennite
<br />Standard System less,th,an,,,?00 ~al. DSF 245,00 10.00
<br />Standard System, mpr~ than 1000 ~1. DSF:
<br />capp!ng Fill 415.00 10,00
<br />DispoSal Trenches in Sapwlite 245.00 10,00
<br />Gray Water Waste Disposal Sump 120.00 10,00
<br />14oldin~ T~nk 245.00 10,00
<br />Redundant System 245,00 10,00
<br /> Sand Pilfer 445.00: I 10,00
<br /> ~eepa$~ ,Tr~p,.e..h,, 245.00 10,00
<br /> Steep Slope 245.00 10,00
<br /> Tile Dewatefing System 350.00 10,00
<br /> Plan Review
<br /> >600 gal. DSF,< 100 I' gal. DSF 100.00 .0{)
<br /> (For eaoh additional ~00 g~!, D~I: 25.00 .00
<br /> Al!erati,pns .................................. 245.00 10.00
<br /> Construction P~rmit Renewal (Field Visits) 150.00 10,00
<br /> Conslmction Permit Rgnewal (No Field Visits) 85.00 10,00
<br /> ~xisting Sys~ Evgluation P,~ort 150.00 10,00
<br /> Auih0ri~atlPn Notice (Field Visit) '150,00 10,00
<br /> AuthorizatiOn Notic~ (No Field ViSit) g5,00 10.00
<br /> Annu~,! ,Ev,~[?..at.i,o..n ofAlteraat/v~ Systom 150,00 I0,00
<br /> Annual Evaluation of Large System 90,00 10,00
<br /> 1Mmper Track Inspection~ First truck 50.00 .00
<br /> Other
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<br />(Mark if Applicable to this Applicatipn) ) Test Holes a~e D~g
<br /> ) I will ~all when Test Holes Dug
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<br />) I am perfbnnin8 work on a property I own or occupy
<br />) I am a teglstered builder or( ) the authorized representative
<br />) ~r~c work wilI be performed by a DEQ Licensed Installer
<br />) Other
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<br />Residential Sinale Famil<
<br />Site Evaluation, first lot 245,00 20.00
<br />Site Evaluation, ca, addl. lot 205.00 20.00
<br />Construction permit
<br />Standaed System 245,00 10.00
<br />Capping Fill 415,00 10,00
<br />Dimaosal Trench in Savrolite 245,00 10,00
<br />Gray Water Disposal Sump 120,00 I0,00
<br />Holding Tank 245;00 10.00
<br />Pressur~ Distribution 350.00 10,00
<br />Redundant 245.00 10.00
<br />.... :.S a.,n..d Fdtat 445,00 I0.00
<br />Seepal~e Trench 24~,00 1,0,00
<br /> Stee~ S!o~e 245.0{) 10.00
<br /> Tile Dewatering 350.00 I0,00
<br /> AlteratiOn 24~.00 10-00
<br /> Repair, Major (drainfield) 115,00 10.00
<br /> Repair, Minor (tank) 75,00 10,00
<br /> Construction Permit Renewal (Field Visi~ 1S0.O0 10-00
<br /> COnstmcrion Permit Renewal (No Field Visit) 85,00 10,00
<br />Rejnspection Fcc 25,00 ,00
<br />Authorization Notice (Field VJslt} ..................... !50.,09 10,00 I
<br />A~thofizafiou Nofi¢~ (No Field Visit) 85.00 10.00 '. ........
<br />Existing System ~valuatlor~ 150.00 10.00
<br />Annual ~valuafi o n/Alto r~lative System. ............... 150.00 .00
<br />Annual Evaluadon/Tcmp or l-Iardsb p MH 90.00 ,00
<br />Rural Area Variance Site Evaluation 245.00 20,00
<br />: P',~ _ ~ .:~
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<br /> ague o ins
<br />of the Stag of Ot~gon and the oRlinan~es of Marion County.
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<br />NAME OF APPLICANT (please print):
<br />SIGNATURE OF APPLICANT: DATE:
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<br />MC 15-SI REV 2/93
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