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FOR OFFICE USE ONLY
<br />Received t~y:
<br />Zofiing Validation
<br />Date:
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />220 High Stt~et NE
<br /> Saleru, OR 07301
<br />
<br />8:00 a,m- - 4:30 pm Phone 588-5147
<br />Code-A-Phone 588-7904
<br /> FAX 588-7948
<br />
<br />SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />
<br />Property Owner Maililas Address: Phone No.
<br />Auth. A~geaffLeasee ~ilifl8 Address: Phone No-
<br />Coot~ct~'rBusincssNam~&~umbc~/~ *l~t ~O~lC~ ~ C~ Ma'fin ~dd~s~: ' Phone'"' o
<br />DEq licensed ContoUr & No. ~ ~ ~- ~iling Address: ~one No.
<br />
<br />Commercial CDSF - Daily Sewage Flow] s
<br />S ~¢ Evaluatton~ first 1000 Ssi. DSF ..... 245.00 20.0.0
<br />S c Eva ~,Ot 0% es. midi. 500 Sa!,. DSF 75.00 !0,O0/m ......
<br />Construction, ~ Repair permits
<br />~S andard Si,stem less than I000 &al. IS~F , 245.00 10,00
<br />Standard System more than 10~0 ~al. DSF: ....
<br />$¢45.00 + $15 each midL 500 g. al, DSF , , 10.00,
<br />Capping Fill 41~.00 .... 10.00
<br />Disposal Trenches in SaPmlite 245,00 10.00
<br />_Gray Water Wa~¢,l~}spoaal Surup , , I5'0,00 I0.00
<br />l-Ioldin$ ,Tatlk ....... ~48.Q0 10-00
<br />Fr*ssure Distribution .... 350.09 10,00
<br />Eedund,ant System i 248.00 I0.00
<br /> 2;~,~d .Filter .. 44~-00 I0,00
<br />Seepage T~n~h 245,00 ....... .10.00
<br />Stop S]0p~ ..... 245.00 10,00
<br />. TiTtle DewaU~fing Sy,s[cm 380,00 10.00
<br />Plan Review ........
<br />>,q9~0 &a!: DSF, < 1001 gal D,s? 100,00 ,00
<br />: (~Zd~pr~bNO YTLTEi~)
<br />~ (Poreaeh additional ~,00 gal. DSP 25,00 .00
<br />Alt.era~ions 245.00. 10.00
<br /> Rep3![I Minor , . 75.00 10,00 ....
<br /> Construction permit Renewal (Field Visits) : 150.00 10.00
<br /> Const mctio,n.perrait Renewal 0qo Field ,~,isits) $5,00 10.00,,
<br /> Exi~tin~ystem Evaluation Re~9~ 150.00 I0,00
<br /> Authorization Notice (Field visit} 150,00 ,: 10,00
<br /> Amhodzat!on Notice ¢No Field Visit),,. 85.00 , i 10.00
<br /> Annu~,, Evaluation ofAIteruativ9 System ' 150.00 .... 10,00
<br /> ,Annua Evaluation ofL,a,~9 System .90.00 10.00
<br /> Pumper Truck lnspectio,n~,First track ~0,00 .00
<br /> Pp,r~pcr Truck Inspect on. ,~a.. midi. truck 35.00 ,00
<br /> Other
<br />
<br />TeJf Applicable to this Application)
<br /> st Holes are Dug
<br /> ) I will call when Test Holes Dug
<br />
<br /> am perfoBnins work on a pwpg~y I own or occupy
<br /> am a registered builder 0t ( ) thc authorized ~presentalivc
<br /> work will be peffo~ed by a DEQ Licen~d Insmller
<br />Other
<br />
<br />MC 1S-SI REV 2/93
<br />
<br /> R*tl0d~ntial Sin~le Famiiy
<br /> Site Evaluation, first lot 245,00 ~0.00
<br /> Sim Evaluatton~ ea. midi, lot 205.00 20.00
<br /> Construction permit
<br /> Standard 'S~stcm,' 245.00 10.0'0
<br />~ppinsFill , , 415,00 10,O0
<br />Gm}, Wat~/Disposal Sump ,, 120,00 10,00
<br />Holding Tank 245.00 10.00
<br />Pressure Distdbu~ip,n 350,00 10.00
<br />Redundant ..... 245.00 0.00
<br />$and Filter ........... 445-00 10.00 ....
<br />S~epage 'I'n,~nch 245,00 10,00
<br />St,eep Slope 245,00, ,, 10,00
<br />Tile Dewat~fin$ a50.99' 10.o0
<br /> 115.0o 10.00 ....
<br /> .... 75.00 10,00
<br /> Construe,lion Permit Renewal (Field V!,~j3} 150.00 10-0Q ....
<br /> Construction Pemait Rg,n.ewal (No Field Visit) gS.O0 10,00
<br /> R. cinspection Fee .... 7~$,00 , .,q.O
<br /> Authorizati~ Notice (Field Visit) ! 50.00 10.00 ....
<br /> Authori~.a~ton Notice (No Field Visit) , ,, 85.00 10,00
<br /> Annual Evaluatio~/Altematiw Systeru .... 150-00 .00
<br /> Annual Evaluaqon/Temp, or Hardship MH 90.00 .00
<br /> ~ural Area Variance 'q'i't e EvaluatiOn 24'~',00 20.00
<br />
<br /> Total ,$.
<br /> Receipt No.
<br />I agree to install according to the submitted plans and specifications, the laws
<br />of the State of O~gon and the ordinances of Marion County,
<br />
<br /> _Tavc.e' CEmoI :'Z-
<br />NAME OF/~cI~LICANT (pleasqi~rint):
<br />
<br />DATE:
<br />
<br />
<br />
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