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'Received By: .j v4d-¥~ff-
<br />Zoning Validation' ~
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<br />MARION COUNTY BUILDING INSPECTION
<br /> 220 High sa~ct NE
<br /> S~lem. OK97~01
<br />
<br />8:00 a.m. - 4:30 pm Phone 588-5147
<br />Code-A-Pkone 585-7904
<br /> FAX 588-7948
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<br />Location of Installat ~ ~ ~) ·
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<br /> commercial fDSF - Dagv Sewage Flow) ........ 8
<br /> Site Evalua,~,nt ea. ~fll, 500 ~1, DSF 75.00 20,0,0/m
<br /> Construction ~ ~pair Pe~i~ .................
<br /> St~n~,~ystem less th~ 1000 gal, DSF 245,00 , , ~0.00
<br /> S~ S~s~m mo~ th~ 1000 ~al. DSF:
<br /> $~4~:00 + $15 each ~d[. 500 gal, DSF "',',"," 'i0.00
<br /> Cippiag Fill 415.00 10.00
<br /> Disposal T~nchca in Saprolite 245.~ 10,00
<br /> ~v W~iciWaate Dispoal Sump ...... 120.00
<br />
<br /> PP~su~ Distribution 3~0,00 .... ~0,00
<br /> nd
<br /> undant Sys~ 245,00 10.00
<br /> Sdnd Eilter 445,00
<br /> gtbep Slope 245.00 10.00
<br /> T Ie Duwatefiag Sys~m 3,f~-~0
<br /> PIm,R~iew
<br /> ~ 600 gal. DSF,~100I gal, DSF 10,0,00 .00
<br /> ].~or each additional 500'gal, DSF 25.00 .00
<br /> AA~ ¢~tions 245.00 10.90 .....................
<br /> pair, Minor 75.00 10,00
<br />.,~ns~¢tioa Pe~it Re~ (Field Visits) ] ~ 50.00 10.00
<br />k~nsimctlon E0~it Rental ~o ~iel~iaitS) SS.00 10.00
<br />
<br />f A~thod2arion N0ric~ (Field Visit) 2 i~0.00 10.00
<br /> Aothodzatloa Notice ~o Field Visit) 85.00 i0.00
<br /> AMual Evaluation of Al~matiw System ; 150.00 10.00
<br /> Ahaual Evaluation of~e Sys~m 90,00 10,00
<br /> ~mp~r Tm~k Inspection, Flint track 50.00 .00
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<br />(Mark if Applicable to this Application)
<br />( ) Test Holes at~ D~S
<br />( , ) I will call when Test Hrdes Dug
<br />
<br />(~ I am performing work on a property I own or occupy
<br />( )Iamaregistcrcdbuildcror( )thcauthorizcdr~prescntative
<br />C'~ Thc work will bc performed by a DEQ Licensed Instal(er
<br />(/) Olhcr '
<br />
<br />MC 15-SI REV 2/93
<br />
<br /> Residential Single Family $
<br /> Site Evalugti,?n~ first lot 245,00 ..... 20.00
<br /> Site Eva,IpationI ea. addl. lot 205,,qq .... 20.00
<br /> Construction permit ..........
<br /> Standard System ~4,~:9.0., ,, 10.00
<br /> Capplng Fill ...... 415,00 10,00,,
<br />Disposal Trench in Sapr~.!,i~ 24~.Q0 10,0O
<br />Gray Water Disposal Sump ........ 120.00 10.00
<br />Holdin~ Tank ........... 245.00 t,0.,00 .....
<br />pressure Dis~fi~ut. ion ~50,00 10,00
<br />Redp,n0gnt 245,00 0,00
<br />Sand FiltoE ........... 445.00 10.00 , ,,
<br />Seepage Trench 245,00 10,00
<br />Steep Slope ......... 245.00 I0,00
<br />Tile Dcwatefing 350.00 10.00
<br />Alteration ,,2,4.~...00 iO.O0
<br />Repair, Major (drainfield) 115,00 I0.00
<br />Repair, Minor (tank) 75.00 10,00
<br />Constroction permit Renewal (Field Visit) 150,00 10.00
<br />Construction Permit Renewal ('No Field Visit) 85.00 10,00
<br />Reinsp~ction Fee 25,00 ,00 ...............
<br />Authorization Notice (Field Visit) 150-00 ~ 9:Q,~ ......
<br />Authorization Notice (No Field Visit) SS.00,,.,, .,,,,.10.00
<br />Existing System Evaluation 150.00 10,00
<br />Annual l~valuation/Altemafive System 150.00 .00
<br />A~nua[ Evaluation/q'emp, or Hardship MH 90.00 ,00
<br />.....R~.,.ml Area Va~nce Site Evaluation 245,00 20,00
<br />
<br /> [O~
<br /> ,,1-,,ts,, qq. Cb L
<br />I agt~e to nsta accord ag to the subm t~d plans and spec fiL'~tlo~s, the raw~
<br />of the S~.to of Or~gon and the ordinances of Marion County.
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<br />NAME OF APPLICANT (please print):
<br /> //7/? ¢/
<br />SIGNATUP~ OF APPLICANT: / DA/TE: '
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