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FOR OFFICE USE ONLY
<br />Rec¢ive~ By:
<br />Zgning v'~lidation
<br />Date:
<br />
<br />1. Location of Installation
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />220 High ~t~et NE
<br /> Salem. OR97301
<br />
<br /> 8:00 n-m~ ~ 4 30 pm Phone 5g$-5147
<br /> Code-A-Phone 558-7904
<br /> ~tA.X 588-7948
<br />
<br />SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />
<br />2. Con factor Informatmn
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<br />Property Owner ' '"':' Mailing'Address: ' ' 'j' ,Phone N~,'
<br />Auth. Age?t/L~as~e .......... : ~[i~g AddresS: ~one
<br />~t~r ~n~ss'Name & Number ........ ~ling Address: ..... Phone
<br />
<br />~Licensed ~mm~tor &No, : ~' " '
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<br />3. Fees
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<br />Comm~i'al COgF- Daily Sewage Flow~ s
<br />Site Evaluation, first 1000
<br />5i~ ~wiugioa, es: ~dl. 500 ~1. D~' 75.00 20,00/m
<br />~nstmction &Repair Petite: """~:' '
<br />Smnd~ Szs~m le~s than 1000 ~.' DSF 2a5.00, 10.~0
<br />Holding Tp~k ' , 245,00 ! 10.9,0
<br />~dundard S~em 245,00 ~ 10,09
<br />S~p siopc 24~.0,0
<br />~te ~wntednff $~m 3~0.00 ~ 10,00
<br />Plan ~vlew
<br />(Eot e~h additionn1500 ~1., DSF 2~tQ,0. ~ ,00
<br />Alterations 2~5.00 J ~0,00
<br />R~palr, Minor 75;97 · ~ 10~00 "':
<br />~Co~stmction Pe~it ~newal ~o~ e d Vis s) ~,9~ ...... ~ 10.00
<br />Annu~ Bwlustion of Altom~ve S~s~m
<br /> Annual Evaluation of~m 90,0~ ~ 10.00
<br /> ,
<br />
<br />L Residentiai ginEle FamilY .... ~
<br />Site Ey.al~stion~ fit'at lot 245,00 20,00
<br />Site EvalUation, e~ add]. tet 205.00 20,00
<br />Cohstroction permit
<br />..,.Standard System 245','0~ 10,0~,.
<br />Capping Fill 415.00 10.00
<br />Disuo~a{ Trench ia Saotolite 245.00 ~0,00
<br />Gray W~tor Disposal Samp 120.00 10.00
<br /> ltolding Tank ,,, 2,;5,00 10,00
<br /> Pressu~ Distribution ,,,3~0,00 10,00
<br /> Redundant ,2,45,00 10.00
<br />:~d Filter .... :445,00 10,00
<br />Seepag~ Trench,,, 245.00 10,00 ,,
<br />Steep,Slope: 2.4.5 00 I0.00
<br />Tile D~w.~fing 350,00 ,, ,~,0-00
<br />Alteration 245,00 10,00
<br />l~,epair~ Maj6r (dtainfieid) ' 115.00 10,00
<br />l~pair, Miu0r (tallk) 75.00 10,00 ~
<br />Const~cfion Permit R~gewal (Field Visit) 150,00 10,00
<br />.._Construction Permit Renew.¥.,(No F e d V s t) s $.-.00 ~0.00 ~
<br />Reinspec~ipn Fee 25,00 .00
<br />
<br />,,,A~hotization Notice (F e,,,d v s t) 150.00 "10,00
<br />.= .Agil~ofiz~ti0n Not/cc f'go ,'Fik d V s t) ~ 5,.00 10,00 ....
<br /> ·Existing System EvaluatiOn ,, , 15Q,00 10,00
<br /> Annual !Uvalualio ~/Alte restive System 150.00 .00
<br /> Annual ~v~u. ~(ion/'remp, or Hardship MH' 90,00 ,00
<br /> Rural Ama V~iance Site ~val~on 245.00 '20,00
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<br />" , · ": Recep N6
<br />
<br />(Madm if Applicable to this Application) : '~ ::' ' °t'lh5 State 0fOreg°n ~md'&e °ndiUanCes °fMafi°n C°uniy'
<br />) Test Holes am Dug ' ' "'
<br />) ! will ~all when Test Holes Dug
<br />
<br /> ) I am performing work on a propegty I own or occupy ': NAME OF APPLICANT (please print):
<br /> ) I am a t~gisteted builder or ( ) the authorized t~reseUtoti~e! '
<br /> ) Tho work will be performed b); a DEQ:Li~ehs~d I~staller i'
<br /> ) Other~
<br />
<br />SIGNATURE OF APPLICANT: DATE:
<br />
<br />MC 15-SI REV 2/93
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