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MARION COUNTY BUILDING INSPECTION
<br /> · 220 Hisb Steer NE
<br /> Satcrrh OR, 97301
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<br />8:00 a.m.-4:30 pm Phone 588-5147
<br />Code-A-Phone 588-7904
<br /> FAX SS8-7948
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<br />MAEION COUNTY
<br />BUILDIN iNSPECYJON
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<br /> SITE EVALUATION AND/OR SEPTIC PlgR1VIIT APPLICATION
<br />Location of Installation
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<br />Subdivision ~ ~ Imf ~ Block
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<br />Section I I tow,shiV"l'h ~ I ~.S~ ~ [ ~n~ ~ m~
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<br />2, C0ntraet0r lnfi; 'mation ............ ~ s_~ ~'",.z2~/~-::~.~2~ \
<br />
<br /> r~3~--~,~.~.~,~x .cji c,~rT~o,~x
<br />AEth, Agcn~as~ ~ ~l[ng Address: ' Phon~ No,
<br /> ' ', ............ * ~ilin dd~ss' '"'" '~'~'~ Phone No. > '9 , ~ ~ -
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<br />DEQ Licensed Contractor & No~ ~k~ ~ ~ ~iling Add~ss~ ~,~[ ~ Phone No. ~ ~ ...~[
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<br />Commercial (DSF - Daily Se~a~e Flow)
<br />Site Evaluation, flr~ !Q00 ga!, ~SF 245,00 20,00
<br />Site Evaluation~ ca, addl, 500 Ssi. DSF 75,00 20,00/m
<br />~g;s~ra~iion & Re,air ~emits
<br />Standard Sy~m Igss than 1000 8gl, DSF 245,00 10,00
<br />, ,~dard System mow than 1000 ~aI. DsP:
<br />~ $24~,00 + $15 each addl. 500 gal. DSF 10.00
<br />Cappln~ Fill 415,00
<br />Disposal Trenches in Sapmlite 245.00 10,00
<br />Gray Water Waste Disposal Sump 120.00 10.00
<br />lie]ding Tank 245.00 10.00
<br />P~sst~re Distribution 350.00 10,00
<br />Redundant System 245.00 10,00
<br /> San~ ~'iJtel , , ...... ~25.00 , 10.00,
<br /> Seepage T~neh 245,00 10,00
<br /> Steep Slope 245.00 I0.00
<br />Tile Dcwa~eriag System 350,00 10-00
<br />>600 gal, DSF,<IO01 gal. DSF 100.00
<br />(Per ~a~h additional ~00 gal, DSF ~6.00
<br />Alte~Oons 245.00 10.00
<br />ge&~ ......... 7~.00 w.00
<br />Conslmction Pgmit ~newal (Field Visits) 150.00 10.00
<br />~.on$tn c/ion Pe~it Renewal (No Field Visits) 85.00 ' I0.00
<br />~istin$ System Evaluation ~poa 150.00 10.00
<br />Authorization Notice (Field Visit) 150.00 10.00
<br />Authorization Notice ~o Field Visit) 85.00 10~06
<br />Annual Evaluation of Altematiw Sys~m 150,00 10,00
<br />Annual Evaluation of~rge System 90.00 10.00
<br />Pumper Tmek Inspeetlon~ Plmt track 50.00 .00
<br />~mper Tmek Inspection, ea. ~dl. tm~k 35.00
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<br />(Mark if Applicable to this Application)
<br />( ) Test l-loles a~ Dug
<br />( ) I will call wh,n Test Holes Dug
<br />
<br />( ) I am performing work on a property I own or occupy
<br />( ) I am a registered builder or ( ) the authorized representative
<br />~ 'll~e work will be performed by a DEQ Licensed Installer
<br />( )Other
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<br />Res~al Single Family
<br />Site Evaluation, first lot 245.00 20,00
<br />,&i~.,.E.,valuation~ ea. addl. lot 205.00 20,00
<br />Construction permit
<br />Standard ~}!~tem 245.00 I 0.00
<br />Cappiag Fill 413.00 10.O0
<br />Dispoem{ Trench in Saprolite 243,00 ~0,00
<br />Gray Water Disposal Sump , , 120.00 ,10:90 .......
<br />Holding Tank 245.00 10.00
<br />........ ~.rqssu z~ Distribution 350.00 10.00
<br />Redundant : 245.00 I0,00
<br />, Sagd Fi]t~,~ ............................ : 448.00 10.00
<br />Seepage Trench ' 243,00 10.00
<br />Steep ~lope 245,00 10,00
<br />Tile D~watefing 350.00 I0,00
<br />Alteration 245.00
<br />RepairI Major (drainlleld) 11 fi,00 10,00
<br /> R~pair. Minor (tank) 7),0_.~0 10,00
<br /> Construction Permit Rencwa! (F!e!d y!sit) 150.00 10.00
<br /> Construction Permit Renewal (No Field Visit) 85.00 10.00
<br /> Reinspection Fee 25,00 ,00
<br /> Authorization Notic~ (Field Visit) .......... 1 $O.O0 10.00
<br /> Authorization Notice (No Field Visit) SS.00 10.00
<br /> Existing System Evaluation ....... ,, , 150,00 10,00
<br /> Annual Evaluation/Altematiw System 130,00 .00
<br /> Annual Evaluation/Temp. o~ I'fardship MH 90,00 ,00
<br /> Rural Area Variance Site Evaluation 945,00
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<br />· I agree to instalI according to the submitted plans and speeifieaOons, tb¢~aws
<br />of the State of Oregon and the o~dlnances of Marion County.
<br />
<br />MC 15-SI REV 2/93
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