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FOR OFFICE USE ONLY
<br />Received By:
<br />Zoning Validation
<br />Date:
<br />
<br />MARION COUNTY BIJ~DING ]iNSPECTION
<br />220 High Street NE
<br /> Salem, OR97301
<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
<br />
<br /> x Si~,~9. U~ of Stmcm~
<br />Mobile Home Park Spa,e ~.. ~' ~
<br />
<br />2, Contractor Information
<br />
<br />Property Owner f) · Mailing Address: Phone No,
<br />Auth, Agenffl,~asee ~ J//}/{~ ~O/}~ Mailing Address: ?hotlo No.
<br />
<br />'Contractor Business Name & Number ....... ~ - Mailing Address: Phone N~.' .....
<br />DEQ Licensed Contraator & No. Mailing Address: Phone No.
<br />
<br /> m r i I - il eFIow) s
<br /> Site Evaluatlon~ first 1000 gal. DSF ........ 245.00 20,00
<br /> Site Evaluation es. addL 500 ~1. DSF 75.00 20.00/m
<br /> Constmctlon & Repair Permits
<br />
<br />,,,St,.ndard System less than I000 ~¢.I. DSF 245.00 ........ ~0,00
<br />Standard System mom than 1000 gal. DSF: ................
<br />$245.00 + 815 ~ach addh 500A~al, nSF 10,O0
<br />Capp!~ Fill qtS,.09 ..... t0.o0
<br />Disposal Trenches in SaproliF: ........... 245.00 10.00
<br /> Gray Water Waste Disposal Sump ........................ 1.20.00 I0.00
<br />Holding T~0h 245,00 I0.00
<br />Pm~sure Distribution 350.00 10.00
<br />Redundant System 245.00 10.00
<br />~,~nO Filtq, r 445,00 I0,00
<br />Seepage Trench 245.00 , 10.00 ...........
<br />Steep $!opo 248.00 10.00
<br />Tile Dewatefing System 350.00 lq.PO ..........
<br />Plan Review
<br />>'600 gal. DSF~-< 100 lA,al, nSF 100,00 .00
<br />R~.~3i,rt ,Mi,~ ,qr..,, 75.00 10.00
<br /> Construction Permit Rene,wal (Fi,eld, Vislts) .... 1~0.00 .....10.00 .......
<br /> Cons{ri,etlon Permit Renewal (No Field Visits) 85.00 10,00
<br /> Exis60g System Evaluation Re]~o a 150.00 10.00
<br /> Authodzatlon Notlee (Field Visit) 150.00 10.00
<br /> Authorization Notice ['No Field V~slt) $5.00 10-00
<br /> Annual Evaluation of Altornatlve System 150.00 10.00
<br />
<br /> Pumper Track Inspection, First truck 50,00 ,00
<br />
<br />(Mark if Applicable to this Application)
<br />(t~) Test l-Iolcs am Dug
<br /> ) I will call when Test Holes Dug
<br />
<br />) I am pcffonnlng work on a property I own or occupy
<br />) I am a registered builder or ( ) the authorized t~pre~ntative
<br />) Tim work will be performed by a DEQ Licensed Installer
<br />) Othe~
<br />
<br />Residential Sinele Family $
<br />Site Evaluatlon~ firat lot 245.0Q ......... 20.00
<br />Sits Evaloation. es, addl. lot 205,0~) .... 20.00
<br />Construction ermlt
<br /> 245.00 10.00 2'2~-~'-
<br />Standard System ...............
<br />Capping Fill ........ ~[5.00 10.00
<br />Disposal Trench in Sapm[iie ........... 245.00 10.00
<br />G y3.,v Water Disposal Sump t20.00 10.00
<br />Holding Tank ...... ~45.00 10.00
<br />Pressure Distribution 350,00 10,00
<br />Redundant 245,00 [0.00
<br />Sand Filter 445.00 I 0.00
<br />Seepage T~nch 245.00 10,00
<br />Steep $!o~e 245.00 10.00
<br />Tile Dewatefing 350.00 10.00
<br />Alteration 245.00 10.00
<br />Repair~ Major (draJll fleld) I 15.00 10.00
<br />Repair, Minor (tank) 75.00 10.00
<br />Construction Permit Renewal (Field Visit)~ 150,00 10,00
<br />Construction Permit Renewal (No Field Visit) 85.00 10.00
<br />Reinspeetion Fcc 25.00 .00
<br />Authorization Notice (Field Visit) 150.00 I0,00
<br />Authorization Notice (No Field Visit) 85.00 10.00
<br />Existing System Evaluation 150.00 10.00
<br />Annual Evaluation/Alternative System 150,00 .00
<br />Annual Evaluation?r~mp. or Hardship Mil 90.00 ,00
<br />Rural Area Variance Sit* Evaluation 245,00 20.00
<br />
<br /> P, eeeipt No.
<br />I ague to install according to the submitted plans and specifications, the laws
<br />of the State of Presort and the ordinan<~ of Marion County.
<br />
<br />NA/~Fq. OF APPLICANT (please print):
<br />SIG~I~)F APPLI6ANT: DATE:
<br />
<br />MC D-Si REV 2/93
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