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FOR OFFICE USE ONLY MARION COUNTY BUILDING INSPECTION
<br /> ~ecvived BS,: 22o ~ir~
<br /> Zoning Viflidation Salem, OR 97301
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<br /> ~de-A-Phonc
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<br /> S~E EV~UA~ON ~/OR SEP~C PE~ ~PLI~
<br />1. Location of Installation
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<br />COntractor Infor~a~tior~
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<br />Commercial (DaF - Daily Sewa~e'~'lowl
<br />,Si~e Evaluatlon~ first IOOQ, [~al. DSF .,,1 245,00 2O,0~,
<br />Site ~uation~ es. ~dl+ 500 ~. DSF 7,5.00 20.~/m
<br />C6nstmctio~ ~ Repair,~e~iis
<br />S~ndard S~m less than 1000 ~aI,,DS~ 245~00 10,00
<br />S~dl~ ~y~m mO~ than 1000 ~1. DSF:
<br />$245.00 · $1~ e~b ~dl. ~00 gal ~F, 10,0o
<br />~pplng Fill 415.00 1,~,00
<br />G~y Water Was~ Disposal Sump ~, 00 10.00
<br /> H61ding Ts~k ,, ..... 245.00 10,00
<br />p~ssum Dian%utlon ,,, ~50,~ 10.00
<br />~duadant ~yste~, 245.Q0 10.00
<br />Sa~d Fd eL. ~5.00
<br />$cbpaRe T~nch 245.00, 10,00
<br />Steep ~ope.,. 245,00 ,10,00
<br />~:~le ~wate6ng Sys~m 350.00, I0.00
<br />>600"ga. DSF,~I,Q01 ~ DSF lO0.q0 .00
<br />R~palr~ Minor , ,,, 75.00 10,~
<br />Const~ctio~ Fc~it Renewal (F~
<br />~nstmcd,gn Pe~it Renewal ~ Field Visits) 85.00 19-00
<br />~/*~/ag System Ev~luagon Rcpoa 150.00 10.00
<br />Autho~tion Notlcc (Field, Visit) I$0,00 10-00
<br />Authorization Notki ~o Fiqld Visit) .... g$.~ 10.00
<br />Annual Evalu~tlon q~Altem~iv~ $~st~m 150.~ 10.90
<br />Ann~l Ewluition of~r~ $~stem 90.00, 10,00
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<br />(M~'rk i£Applicable to this Applicatio0)
<br />( ) Test Holes are Dug
<br />( ) I will ~all when Test Holes Dug
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<br /> ) 1 am performing work on a properly I own or occupy
<br />(X,) I am a registered builder or ( ) the authoflzcd i',ep~sen~ative
<br /> The wogl will be performed by · DEQ Licensed Inslallet
<br /> Other
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<br /> Residential Sin~le Familv' ,,, ' ....
<br /> Site EvaluatJon~ first lot, 245.00 20.00
<br /> Site Evaluationt e~- addl, lot 205.00 20.00 ,,
<br /> Construction permit
<br /> S~nda~ Sy~m 245.00 I0:00
<br /> C~oth~ ~i{I 415.00 10,00
<br /> ~i~o~l T~e~ in ~umli~ 245~00 1O-OO
<br /> Gray Water Di~o~[ Su~ 120.00 10,00
<br /> Hdding Tauk 245.00 lp.00
<br /> Pgs~g Di~bu~]~n 350.0~ 10-00
<br /> Redundaut 245.00 10,00
<br /> ~nd Filter 445,00,, 10-00
<br /> ~epage Tmn~ 245,.00 10.00
<br /> S~ep Slop~ 245.00 ,
<br /> Til~ D~wate~ng
<br /> Alteration 245:00 10,00
<br /> Repair~ Ma}or (dm{n~eld) ,, 115.00 10,00
<br /> ,~ait~ Miuo/~nk) 75,~ I0,~
<br /> Construction Yc~it ~newal (~eld,yisil) 150.00 10.00
<br /> caoamction Pe~{t ~uewa] ~o Field ~isit) 85.00 19,00
<br /> Reiu~ti0u Fee I , Zf-00 ~ ,
<br />~utho~tiou ~OfiCe (Field Vi~i0 150.00 10,00
<br />__&utho~/ion Notice (No Field Visi0 85.00 10.00
<br />E~s~ng Sysgm Ev~on Ii0,00 10.00
<br />Annual Evalugtio~A]~mative System 150.00 .00
<br />~ Evaluaio~emp. or Ha~shiE ~' 90.00 .00
<br />~ Ama V~anco ~i~ Ev~u~ion , 245.0~ 20.00
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<br /> P~ccipt No.
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<br />o~the Sta~ of Oreso~ and the ordlnance~ of Matlon C~uniy,
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<br />NAME OF APPLICA1VF (plea~se print):
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<br />MC IS-SI REV 2/93
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