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IZoning Validatio~
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<br />FOR OFFICE USE~.NLY
<br />Received'By: ~,,
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<br />MARION COUNTY BUILDING iNSPECTION
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<br /> Salem, OP, 97~01
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<br /> 8:00 a.m. - 4:30 pm Phone 588-5147
<br /> Code-A-Phone 588-7904
<br /> F.~,X 588-7948
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<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1. Location of Installation J3~ o~' 5'?o c.a.~a~c r ~T,
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<br />i figt 2 4 994
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<br />BUILDING INSPECTION
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<br />Subdivision ~o ~ ] ~*~ ~ ~]~""'~' ~t !~ Block L No. Emolovees
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<br />2. Contrac~0r_l~ormafion 3te~ ~ Ca,r,~ ,
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<br />Auth. Archi/Denser Mailing Address: Phone No,
<br />DEQ LicenseJ C°nt"~ract°r &/N°' ~.~t'~( ~/~ ~7~ Maling Add~ss:~e~. Dr ~,,2~ Phone No.
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<br />~m-ercial IT)SF - Daily Sewage Flow) ........ '$
<br />Sit~ Evataation~ tint 1000 rial, DSF 24,~,.,9Q 20.o0
<br />Site EvaluatlonI ea. addl. 500 ~al, I~F,, 73,00 20,O0/m
<br />Construction & Repair Permits ....
<br />Standard Sy..~.t ¢.rn, l,css than 1000 I~al, DSF 245.00 ~,,00
<br />Standard Syst*m mot* than 10,0,? Sa!,. DSF:
<br />S245~00 + $15 each addl. 500 rial, DSF ....... 10,00
<br />Cappin[¢ Fill ......... 415.00 10,00
<br /> Disposal Trench~.s,,!q, ~,~pmlite 245,00 ......... 10.00
<br /> ,Gray Water Waste D sposa Sump 120.00 10.00
<br /> Holding TalIk 245,00 IQ:00
<br /> P~s~um Distribution .............. 330.00 ~.0,,00
<br /> Redundant System ....... 243.00 tqm,09
<br />~l=d '"Ei[t *r 4~$,0Q 10-0O
<br />Se~l>a~e Trench 245.Q,0,, 10,00
<br />Steep Slope ....... 245,00 ,1.1~.00
<br />Tile DewateO,~S, System 35Qn00 10.00
<br />Plan Review
<br />>600 gal. DSF,~I001 gal. DS..F. .... 100.1)0
<br />(cra~y,t gA~tn ~'tt,TEILq~
<br />(For each additional 500 ria!.,,,,DSF 2~.0~ .... ,00
<br /> Altcratlons 245,00 10.00
<br /> Repalr~ Minor ,,,, , 7~,.90 10.00
<br /> Constmetlon Permit Renewal (Field Visits) 150,00 10.00
<br /> Constmctlon Pcrm,i,[,R~n~va {No F e d V s t~) 8~,-00 10,00
<br /> Existing System l~valuation,Re, pott 150,00 .... 10.00
<br /> Authorization Notice (Field Visit) 150,00 10,00
<br /> Authorization Notice (N9 l~icld visit) ,, 85,00 10.00
<br /> Annual Evaluation of Altcra~~,i,v¢ System 150-00 10.00
<br /> Annual Evaluation of Lame System 90.00 10.00
<br /> Pumper Truq,g,,In spect on, F mt truck ...... $0,00 .00
<br /> Pumper Track lnsoection, ea. addh tmck ...... 35.00 ,00
<br /> Other
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<br /> "'R~sidentia[Single Family $
<br /> Sit~ Evaluation, first lot 2~,fi.O0 "20100
<br /> Constmct!?~ per,it
<br /> Standard System 245.00 10.00
<br /> Capping Fill ......... 415.00 10.00
<br /> Di~o~l T<nch in Sa~mlite ............ 24~-00 ~ 0-00
<br /> Gray W~r Dispoml Sump 120.00 10,00
<br /> Holding Tank, , 245.00 ...... 19.00
<br />P~ssu~ Distfibuti~,n 350.00 ..... 1,0.00
<br />~nd Filter 44fi.00 10.00
<br />~epage Tnnch 24fi.00 10.00
<br />; SMcp Sieve 245,00 10.00
<br />~tc ~fin8 3~0,00 10.00
<br /> Altamtion ...... ,,.~,$90 10,00
<br /> Repair~ ~jor (dminfleld) ........ 115.00 10.00
<br /> ~pai[ ~nor (~k) 75.00 10,00
<br /> Construction Pe~it RenewM {Field Visit),, 150.00 10.00
<br /> Conatmctlon Pe~it Renews ~o F ~ d V s t) 85:~,, 10,00
<br /> Authofiya~iq,a Not ce ~o F v d V s ~$" 85,00 10,00
<br /> ~istthg Sy,stvm Evaluat on .... 150-00 10.00 .....
<br /> Annual Evaluatio~Al~m~ve System 150.00 .00
<br /> Annual Ev~uatio~omp, or Ha~ship ~I 90,00 .00
<br /> Rural ABa V~ancc Si~ ~valuat~on ' ~45,00 20.00
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<br /> l~ceipt No.
<br />I agree to install aooordltlS to the submitted plates and speoifiealions, thc laws
<br />of thc State of Oregon and the ordinances of M~fion County.
<br />
<br />NAME OF APPLICANT (please print):
<br />
<br />(Mark if Applicable to this Application) ) Test I{olcs arc Dug
<br /> ) I will gall when Test Holes Du8
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<br />t am pcrtbrmins wo~'k on a pwperty I own or occupy
<br />! am a rcsistercd builder or ( ) the authorized representative
<br />The work will be performed by a DEQ Licensed Installer
<br />Other
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<br />MC 15-SI REV 2/93
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