|
MARION COUNTY BUILDING INSPECTION
<br /> 220 High Stz~et NE
<br /> Salem, OR97301
<br />
<br />8:00 a.m, - 4:30 pm Phone 588-$147
<br />
<br /> SITE ~V~UA~ON ~/OR SEPTIC PE~IT ~PLICATION ~
<br />1. Location of Installation
<br />
<br />Subdivis~On ~'~ ~.. ~ ~t ~ Block ~ -- o.~m Iow~s
<br />Mobil, ~o.* ,ark ........... "~ ~oa==, ~' ~ ~=~' 3'
<br />
<br />2, ¢0ntr,aOor Information
<br />
<br /> Commercial (DSF - Daily Sewa°e'Fio~;~ ............ $
<br /> Site,,~y'aluationt fi~ 1000 8al, D$P ~45.00 20.00
<br /> $[~,,,~valuat/0n~ em addL 500 ~1. DSF 7L00 20.00/m , ............
<br /> S~nda~ S~S~~ les~ th~ 1000 gal. DSF 245,00 10,00
<br /> Smn~ $yaem mo~ tha~ 1000 ~1. D~:
<br />.... },~5.00 + Sl 5 e~h ~dl. 500 gal, DSP, 10.00 .....
<br /> ~ 415,00 10.00
<br />Capping Fill ..............
<br />Di$poaaI Trenches in S~mli~ 245.00 10.00
<br />Holding Tank 245,00 I0,00
<br />,, ~*su~ Diafibution 350.00 I0.00
<br />...... ~ep S[op~ 245.00 10.00
<br />Tile Dewatefing System 350,00 10.00
<br />Plan ~evlew
<br />>600 gal, DSF.<1001 ~1, DS~ 100,00 ,00
<br />
<br /> (Fote~h ~ditianal 500 ~1. DSF 25.00 .00
<br />
<br /> Repaic, Minor 75.00 10.00
<br /> Construction Pe~it Renewal (Field Visits) 150;00 10.00
<br />
<br />....... ~onstmcfion Pe~it ~n~wal ~o Field Visits) 85.00 10.00
<br />~iallng System Evaluation Rcpod 150.00 I0.00
<br />Autho~zation Notice (Field Visit) 150.00 10.00
<br />Ahthofization NotiCe ~o Field Visit} 85.00 10.00
<br /> Annual Evaluation of A}~mative,gyaem , ,, 1,50.99: , , 10,:99 ............
<br /> An,n~,a}.,~ggluation of~rg¢ System 90.00 10.00
<br /> ~mp¢r Track Inspection, es, ~dl. traCk 35.00 .00
<br />
<br />(M~k if Appllcable to this Application)
<br />(~d)'Test Holes a~ Dug
<br />( ) I will call when Test l-lolcs Dui
<br />
<br />(~0~'am performing work on a property I own or occupy
<br />(~/)] am a registered builder or( ) the authorized representative
<br />( ~."f The Wgrk will be performed by a DEQ Licensed Installer
<br />( ) Other
<br />
<br />MC 15-SI REV 2/93
<br />
<br />~Reside~ti'~i ~'~ngle Family $
<br />Sit~ Evaluationt first I~ ................. 245,00 20,00
<br />Sit* Eval~tion~ ea. ~dl. lot 205,00 20t90 ..............
<br />S~ndaM System 245.00 10.00
<br />C,ag~jnff Fill 415.00 10.00
<br />G~y W~t Dispo~l Sump 120.00 10.00
<br />Holding T~ 245.00 10,00
<br />Pressure Disln3ution 350-00 10.00
<br />Redundant 2¢5-00 10.00
<br />~epage Trench 245.00 10.00
<br />Til~ ~watedn$ 350.00 10,00
<br />Altc~ion 245,00 10-00
<br />~ir, ~n0r (~nk) 75,00 10.00
<br /> Cgn~tmc~pg ~i~ ~pg~l (?ic~yis~t) 1~6~60 i0~00
<br /> ~n~mctlon ~e~it ~hewal ~o Field Visit) 85,00 10,00
<br /> Reinspectioa Fee 25,00 ,00
<br /> Authod~tion Notice (No Field Visit) 85,00 10.00
<br /> ~istin8 System Evaluation 150-00 10.00
<br /> Annual Evaluatio~A~vmativc System 150,00 ,00
<br /> Annual Evaluatlo~emp. or Ha~shlp MH 90,00
<br /> ~ml Ama Vafi~ce Si~ Evaluation 245.00 20.00
<br />
<br /> I agra* to install a~cordins to the submitted plans and specificalions, the la s
<br />· o£th~ State of Oregon ~nd the ordlnanc~s of Marion County,
<br />
<br />NAME OF APPLICANT (please print):
<br />SlGN)kTURE OF APPLICANT:
<br />
<br />DATE:
<br />
<br />
<br />
|