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Received By~
<br />'Zoning y~[~g
<br />Date:
<br />
<br /> 220 High Street NE
<br /> satam, oR97501 ! 5 1¢9-
<br />8:00 a.m. - 4:30 pm Phone 588-5147
<br />Code-A-Phone 588-7904 MARI0~ C0[J~J]'Y
<br />FAX 588.7948
<br />
<br />RUJLDINO INS?tiOTI0t~t
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT, APPLICATION. ×//'
<br />1. Location of Installation
<br />
<br />Information
<br />
<br />Commercial (DSF - Daily Sew,a~e Flow} ........... $
<br />Site Evaluation~ Ca, addl, ~00 gal, DSF 75.00 20,00/m
<br />Coa$tmctlon & Repair permits
<br />Standard System less than 1000 8al. DSF 245,00 10.00
<br />Capping Fill 41~.00 i lO.0O
<br />l)inposal Trenche~ in Sapmlite 24S.07 .... ] U~.00
<br />G.~ Water Waste D~saosa! Sum~ 120.00 I 10.00
<br />hIolding Tank 245,00 : lO,00
<br />Rodundant System 245.00 10.00
<br />$;t~d Filter 4~,q tO0 10,00
<br />~eepa_,$~ ,,Tr~n,qh ................. 245,00 ! 10.00
<br />Steep Slope 245.00 I 10,00
<br />TiI~ Dewatering System 350.00 i 10.00
<br />Plan Review
<br />>600 gal. DSF,<1001 gal. DSF ............... 100,00 .00
<br />(Fo~ ea¢l~ additional $00 gal. DSF ........... 25,00 i '.00
<br />Alteratlons 245,00
<br />Rep. airI Mi~or 75.00 ! I0,00
<br />Coost~¢tloa Permit Renewal (Field Visits) , , 150.00 ! 10.00 ,
<br /> Construction Permit Renewal {No Field Visits) ...... 85,00 ] l 0.00
<br /> ,Existing System Evaluation R~pon 150.00 i
<br /> Authorization Notice (field Visit) l $0.00 I 10.00
<br /> Authorization Notice (bio F!,~lft V!sit} 85.00 [ 10.00
<br /> Annual Evaluation of AItematlve System 159.00 ! 10,00
<br /> Annual Evaluation of Larg&Syst¢_m., 90.00 ' 10-00
<br /> Puraper Track Inspection, First track 50.00 .o0
<br /> Pum,[~cr Track lnape¢ ion~ aa a d tuck 55.00 ,00
<br />
<br />(Mark if Applieabta to this Application) ) ]'esl Holes are Du8
<br /> ) [ will call when 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 />The work will be peffon'nnd by a DEQ Licensed Installer
<br />OIher
<br />
<br /> Residential Sim,lc Family
<br /> Site Evaluatio% flint lot 245,00 20,00
<br />Site Evaluation, ed, ~ldl. lot 205.00 20.00
<br />Constmctionpennit
<br />Standard System 245,00 10.00
<br />, ,,Capping Fill 415,00 10,00
<br />...... Dispqsa[ Tre,neh in Sapmlite 24:~-00 Io.00
<br />Gray Wale r Disp ~.~,! ,~u mp 120.00 10-00
<br />Holdin~ Tank 24~.00 10.00
<br />Pressure Distn~utio~ 350.00 10.00
<br />Redunda~).t. ..... 245.00 10.00
<br />Sand Filter ,, , 44S.00 10.00
<br />~page T~nc~, , 245,00 10.00
<br />Steep Slope ?,~.5.0,0 ..... 10,00
<br />Tile Dewatefinl~ ..... 350.00 10.00
<br /> Alteration 245.00 ..... 1,0,00
<br /> R~palr, Major {dralnfield) ....... 115.00 10.00
<br /> Rep air, M. ,,i. n9 r (tank) 75.00 10.00
<br /> Construction Permit Renewal (Field Vi:dr) 150.00 10.o0
<br /> Constmcrio~ Permit Renewal {No Field Visit) 85.00 ........ IO.QO
<br /> Reinsp~q~ion Eec 25.00 .00
<br /> Authorization Notice (Field Visit} .... 150,00 10.00
<br /> Authorh'.~.ti,p,n Notice (No F e d V $ ) 85,00 IO.00
<br /> Existin.~ System Evaluation 1 $0:,0,0 10,00
<br /> Annual Evaluarion/Altomeflve,,,~ystem 150.00 .00
<br /> Annual Bvaluatiolfl'emp. or Hardship MH 90,00 .00
<br /> Rural Area Variance Sit~ Evaluation 245.00 20.00
<br />
<br /> Receipt No,
<br />I agree to install ~e~ording to the submitted plans and spccificatlons, thc law~
<br />of the State of'Oregon and the ordinances of Marion County.
<br />
<br />MC IS-Sm REV 2/93
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