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FOR,OFFICE USE ONLY
<br />Received By;
<br />Zoning Validation
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />220 High Street NE
<br /> Salem. OR97301
<br />
<br />8:00 a.m,-4:30 pm Phone $88-5147
<br />Code-A-Phone 588-7904
<br /> FAX ig8-7948
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1. Location of Installation
<br />
<br /> ~/~ ~ ~ Slte No. Use of Stmctu~ ~
<br /> Subdivision ~t Block No,~_empEm levees
<br />
<br />~Seeti°a I ~nshiP ~n~e Zone MaP ~m~lw~ms~ iv: ~s }~
<br />~t Width [ ~t ~pth Ae~s I~g. ~t Comer CO~ Well
<br />
<br />2- {~0ntraet0r Information
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<br />Pmpeay Owner Mailing Address: Phone No.
<br />
<br />Auth. AgentrLeasee Mailing Address: Phone No.
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<br />Contractor Business Name & Number Mailing Address: Phone No.
<br />DEQ Licensed Contractor & No. MailitlS Address: Phone No,
<br />
<br /> Commercial (DSF - Daily Sewage Flow} $
<br /> Site Evaluafiotl, first 1000 gal, DSF ................... 245.00 20.00
<br /> Site Evaluation, ea. addl. 500 gal, DSP ,.,7_$:,00..,, 20,00/m
<br /> Constroetion & Re,pair Permits
<br /> S~andard System less than 100...0,,fLal:,,,p5? 245.o0 lO.OO
<br /> Standard System ruer* than 1000 gal, DSF:
<br /> $245,00 + $15 each addl, $00 gal, D$F 10.00
<br /> c._q~in 4mo0 lo.00
<br /> Disposal Tn:aches in Saprollte 245.00 ..... 10,00
<br /> Gray Water Waste Disposal Sump .,,1,2,~.,00 10,00
<br /> Holding Tank ......... 245,00 10,00
<br /> P~s~u~ Distribution ,,},$.9,00 10,00
<br /> Redundant System 2.~5.00 10,00
<br /> $,nrl ~ilt~~ ........ 445-00 ,10,99
<br /> Seepage Trench ....... ~45,00 10.00
<br /> ~!c~ *p ~!ope 245,00 lO.Oq ......
<br /> Tile Dewatering System ........ 350.00 10.00
<br /> Plan Review
<br /> ....... >,600gaI. DSF,<I001 ~a DSF 100.0.0 .... ,00
<br />
<br /> ~: (Per eaeh,,,~d~idqna1500 gal. DSF 25.00 ,00
<br /> ,, Re.pairI Minor ..... 75.00 , 10,00
<br /> Constmetlon Permit Renewal (Field Visits) .... 150.o0 10,00
<br /> Existing_~yst~m Evaluation Report 150,0.0,,, I0.00
<br /> Authodzatlon N'otiee (Field Visit) ......... 150,00 10.00
<br />
<br />Annual Evaluation of Altornatlve System 150.00"' 10.0.9., ,,
<br />P.._.~,.~:,gr Tmek Inspection, F ~ truck 50.00 .... .00
<br />,__,~.,,,~per Track lnspe¢ on, ea add tuck 35.,..0,0,, ,00
<br />
<br />(Mark if Applicable to this Application) ) 're~l Iloles aw Dug
<br /> ) I will call whe0 Test Holes Dug
<br />
<br />) I am a registered builder or ( ) the authorized representative
<br />) The work will be performed by a DEQ Licensed lns~ller
<br />
<br />MC 1S-SI REV 2/93
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<br /> Residential'"~'i['~i,7'l%milsL $
<br /> Site Evalu atlo n.t,,.f!~[,!c?t 245,00 20,00
<br /> ~i[~ Evaluation: ea. addl. lot 205.00 20,00
<br /> Construction permit .................
<br /> Standard System 245,00 10,00
<br />~ppin~ Fill ........ 415.00 10-00
<br />
<br />Gray Water Disposal Sump 120.00 10,00
<br />Holding Tank ...... · 245.00 10-00
<br />Pressure Distributio~ 350.00. ......... 10,o0
<br />Sand Filter 445,00 10.00
<br />Seepage Trench ......... 2,15.00 10.00
<br />,,Steep, Slope 245.00 10.00
<br />Tile Dewatefin~ ..... 350.00 10,00
<br />Alteration 245,00 10,00
<br />Repalr~ Maio .r,.(d. raigfield) 115-00 10,00 ,,,
<br />Repair, Minor (tank) 75.00
<br />Constmetlon permit Renewal'"~Fieid Visit) 130.00 ........ !,~.90
<br /> Conatmetlon permit Renewal Oq'o Field visit) 85,00 ,, , 10.00
<br /> Reinspeetipo, Fee 25.00 .00
<br /> Authorization Notlee (Pield Visit) 150.00
<br /> Authorization Notice (No.,Figld Visit) 85.00 10,00
<br /> Annual EvaluatiordAlt~mative System 150.00 .00
<br /> Atlnual EvaluatiowTemp, or Hardsh!Jp MH 90.00 .00
<br /> P,u ral Area Variance Site Evaluation 245,00 20-00
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<br /> l~eelpt No,
<br />I agree to install aeeordinS to th* submitted plans and specifications, the laws
<br />of the State o£Oregon and the ordinances of Marion County.
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