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FOR OFFIC,~. U~E ONLV-~
<br />'Received By: ~ ~, U~.
<br /> Zoning V i~tioa -
<br />
<br />8:00 ~m, - 4:30 pm Phone 588,5147
<br /> Code-A-Phone 588-7904
<br />
<br /> SITE EVALUATION AND/OR SEPTIC pERMIT
<br />ltion of Installation ~,y~ n,
<br />
<br />Auth, Ageat/L~asee 0 (_~ Mailin$ Address: Phone NO,
<br />C~r~ontractorr,~,~ Busine;;~ ~ ,b~_~& ~u~ome & Nu bet -~w"7 ...... ~ Mallins Ad.~ phone,, No.
<br />DF, Q Licensed (C1}nti-agtor & No. Mailing Address: Phone No.
<br />
<br />Comlllercial (DSF - Daily Sewage Flow} $
<br />Ste Evaluation~ tint 1000 gal, DSF 245,00 20.00
<br />S e I~va uat o~ ca, addl. 500 gal. DS}' ..... 75.00 20.00/m
<br />....Construction & Pt:pair Pe .n~ts
<br /> Standard Systqm less than 1000 gal, DSI? 245.00 10,00
<br /> Standard Syste~ mom than 1000 ~al, DSF:
<br /> $245,00 4- $~,,~ e~h addl. 500 gal. DSF 10,00
<br />
<br /> Disposa! Trenches !~.,,.8aprolit~ .... 245,00 10.00
<br /> Gray Water Wast~ D sposal,,~ump 120.00 10,00
<br /> }loldinl~ Tank . 245,00 10,00
<br />
<br />Redundant System ...... 245.00 I0,00 .....
<br />Sand Filter 445.00 10.00
<br />$ccpa~c Tmpqh '245.00, ,, I0.00
<br />St~cp Slope ...... 24:5-00 10,00
<br />T~lq,,Dcwatcdng System ........ 350,00 10.00
<br />Plan Review
<br /> t&oo .00
<br />?600 gal, DSF,<1001 gal, DSF ...........
<br />~] '(For each additional 5,q0,gal. DSF 25,00 ,00 ..........
<br />Alterations 245,00 10.00
<br />..... Repair, Minor ..... 75.00 10,00
<br />Construction Permit, Renewal (Field Visits) 1 $0,00 10,00
<br />· Con st mctiq~..Pcrmit Renewal (No Field Visits) 85,00 ....... 1.0t.00
<br />Existinfl System ~valuation Report ..... 150.00 10,00
<br />Authorization Noti~e,~F.ield Visit) ~$0,00 10.00 .......
<br />Authorization Noti¢* (No Field Visit) ............ 85.00 h0.00
<br />Annual Evaluation of Alternative System 150.00 IQr.00
<br />Annual Evaluad,q0 of Large System 90.00 10,00 ..........
<br />Pumpgr Trpck Inspcction~ Fit'st tmek 50-00 ,,, ,00
<br />l%mper Truck tnsp,qci, ion~ ca. addl. track 35.00 .0,0. ....
<br />Other
<br />
<br />(Mnrk if Applicable to this Application) ) Test Holes ar~ Dug
<br /> ) I will call when Test Holes Dug
<br />
<br /> ) I am performing work on a property I own or occupy
<br />(l/~ am a m$istcred builder or ( ) thc authorized r~pr~sgntatiw
<br /> The work will be p¢ffomled by a DEQ Licensed Installer
<br /> Other
<br />
<br /> Residential Sinale Family
<br /> Site t~valuatioa~ Stat lot 245.00 20.00
<br /> Si .tp.]gvaluation~ ea, addl, Io~ ' 205.00 20,00
<br /> Construction permit
<br /> Standard System ,, 24~,,q0.,, I0]00
<br /> Capping Fill ,,, 415.00
<br />~i~0osal Trench in SanmlRc 245,00 , 1 fi.00
<br />Oray Water DDpo~l Sump 120.00 10.00
<br />~Iolding Tank ...... 245.00 10,00
<br />Presspm Distribution ......... 350.00 10,00
<br />P,~dundant 245.00 10.00
<br />
<br /> ,~epage Trench ...... 245.00. ...... 10.00
<br /> Steep Slope 245.00 I0.00
<br /> Tile Duwat~rJE~ ..... 350.00 10:00
<br /> Altaratlon 245.00 10,00
<br /> Repair~ Mater {drai~fi¢ld) I.,~ ~.,00 10-00
<br /> R,pair, Minor (tank) 75.00 10,00
<br /> Construction permrt ILencwal (F~eld Vi$~I) I 150,00 19.00
<br /> Construction.Pc,trait Ben~wal CN'o Field Visit) , 85,00 ,10.00
<br /> Re(nspcction Fee 2~.O0 .00
<br /> Authorization Notice (Field Visit) ........ 150,00 I0.00
<br /> Authorization Notice (No Field visit) ......... 8~,00 10.00
<br /> ,E .~.sting Systam Evaluation 150:0.0, .... 10.00
<br /> Annual Evaluation/Alternative System 150,00 .00
<br /> Annual Pvaluation/T¢mp. or Hardship MH 90,00 .00
<br /> Rural Area VarianCe Sit* i~v..aluation I I~5.00 20'00
<br />
<br /> Receipt No,
<br />I agree to install a~¢ordins to the submittcd plans and specifications, the laws
<br />of the State of Oregon add the ordinances o£ Marion County.
<br />
<br />NAME OF A~Z~LICANT (please print):
<br />SIGNATURE ~i~ Af~PPL"ICANT:
<br />
<br />MC 15-SI REV 2/93
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