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FOR OFFiC~E~V~.~ ~ONLY
<br />~¢c¢ived
<br />Zoning Validation ~
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />
<br />8:00 a,m, - 4:90 pm Phono 588-8147
<br />Code-A-Phone 588-7904
<br /> FAX 588-7948
<br />
<br />MARION COUNTY
<br />
<br /> SITE EVALUATION AND/OR SEPTI,.~ PERMIT A~PI,,..~.ICATION ~UiL01NCl INSPECTION
<br />1. Location of Installation t 57g?.~'/'A-i q,g&[~.,7 ~,~7o~e, No.
<br />
<br />Subdivision ~~ (~ ~t ~/~ Block '~/~ No. E~loYe~S
<br />~tWidlh 15~1 J ~tD,pth ilo/ A~=~ .................... I=~,~t Com,r ~ coml~W,lt [~s ~
<br />
<br />~ctor Information ..................
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<br />PropeRy Owner Mailing Address: Phone No.
<br />Contractor Business Name & Number ~.,,~,_~ ~ ~.' ~t~Cl~l~j~vrl. · Mailing Addr*ss: ~. O. ~ ~ Phon~ No,~. , ~._
<br />DEQ I.icensed Contmcter & No. d-~ ~C[~[ Mailing Aaa.ss: ~l~t ~D R~'~ Phone ~o.
<br />
<br /> Commercial (DSF - Daily Sew~e Flow} $
<br /> Sits Evaluation~ llrst 1000 8aL DSF I 248.00 20.00
<br /> Construction & Repair Permits
<br />Standa[~ ~y ~$~in !¢$S than 1000 gal. DAF 245.00 10,00
<br />, Stands,rd, System more than 1000 gal, DSF: ......
<br />$245.00 + $15 each addl, 500 gg!~,,DS~, 10,00
<br /> Capjllnl~ Fill 415,00 10,00
<br /> Disp,osal Trenches in Sapmllte 24S,00 10,.0,0
<br /> Gray Water Waste Disposal Sump 120-00 10.00
<br /> Ho]dinj~ Tank .......... 245.00 10.00
<br /> Pressure Distribution 350.00 10.00
<br /> Redundant System ............. 245.00 10.00 .......
<br /> gaud Filter 445.00 10.00
<br /> Seepage Trench 2~5,00 10-00
<br /> Steel> Slope ....... 245,00 10,00
<br /> Tile DewaiednKSystem 350.00 10,00
<br /> >600 gal DgF,< 1001 gal. DSF ........ : .I0,0.00 .00
<br /> ( ~ ~LC&DL~,..M~ D FILTERS~
<br /> (For each additional 500 gal. DSF .......... 28,00 ..... .00
<br /> Alterations 245,00 I 0.00
<br /> Repalq Minor 75.00 10,00
<br /> Construction Permit Renewal (Field Visits) ......150,00 10,00
<br /> Construction Permit R~newal ('No Field Visits) 8.5.:00, , 10,00
<br /> Exisdng System Eva]E,atj,Dn Report 150,00 ,la,00
<br /> Authorization Notice (Field Vis~0 150.00 10.00
<br /> Authon.'.za!!,9~ Notice (No Field Visit) 8.,5~00, , 10.00
<br /> Annual Evaluation of Altenlative ~y,s,tem 150.00 10.00
<br /> Annual Evalu a t.i.o.n,,,q,f Lar~ie System 90.00 ,10,00
<br /> Pumper Tmek Inspectlon~ First t.mp,k ,, 50.00 ,00
<br /> pumper Ttock Inspeetion~ ~a, addl, track ........... 35,00 ,00
<br /> Other
<br />
<br />(Mark if Applicable to 1his Application)
<br />( )/T~st 11oles are Dug
<br />( VJ [ will call when Test Holes Dug
<br />
<br />) I am performing work on a property I own or occupy
<br />)Iamamgisleredbuilderar( )theauthofizedrepmsentatiw
<br />) The work will bc perfonned by a DEQ Lkel~sed Installer
<br />) ()lher
<br />
<br />Residential Sinele Fam'i'i'~" $
<br />Site Evaluationr first lot ........... 24~.00 ' 20.00 ~/t ~,-
<br />..... ,.,~, ?~mpdou permit
<br />Standard System ........ 245.00 10,00
<br />Capping Fill 415.00 10,00
<br />Gm}' Water Dispos~l,,Sump 120,00 10,00
<br />Holding Tank ,,,~,~5,,00 10.00
<br />Pmssur* Distffoution 350,00 I0.00
<br />Redundant 245.00 10.00
<br />Sand Filter 445,00 10,09,
<br />8~epage .T. reu~h 245,00 10.00. ,,
<br />Steep Slope ,, , 248,00 10,00
<br />Tile Dewatefin8 ,,, 350.00 10.00
<br />,Alteration ,,.~,.qO 10.00
<br />Repair~ Major (draln fiMd) ...... 115.00 10.00
<br />RepMr, Mia. of, (tank) 75.00 10.00
<br />Construction Permit Renewal (Field Visit) 1 ~0.00 10.00
<br />Construction Permit Renewal (N'o Ficld,,yisi~), 85,00 10,00
<br />Rein~getion F¢¢ ' 25.00 .00
<br />Authofi~'ation Notice (Fiel~l'Visit) 150.00 10.130
<br />Authorization Notke (No Field Visit) 85-00 10.00
<br />Existing System Evaluation 180.00 10.00
<br />Annum t!val~ation/Altt~rnatiYe System 189:99 .00
<br />Annual EvaluationfTemp, ox Ha[.d~h {p MH 90,00 .00
<br />Rural Ama Variance Site Evaluation 245,00 20.00
<br />
<br /> a o ' Receipt No.
<br />of the State of Oregon and thc ordinances of Marion County.
<br />
<br />NAME O~ APPLICANT (please print):
<br />SIGNATIJILE OF APPLICANT: DATE:
<br />
<br />2 15-SI IZJSV 2~93
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