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FOR OFFICE USE ONLY
<br />Re6eived By:
<br />Zoning Validation
<br />Date:
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />220 Hish Street NE
<br /> Kalcm, OR 97301
<br />
<br />8:00 a-m,-4:30 pm Phone 588-5147
<br />Code-A-Phone 588-7004
<br />FAX588-7948
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1. Location of InstaIlatlon
<br />
<br />2 ¢0ntra¢tOr Informa,h~,r~
<br />
<br />DEQ Liccn~d Cohtra¢to¥ & No. i Mailing Address: Phone No,
<br />
<br /> Commercial (DSF -Dailv Sew~e FI0wl
<br /> Site Evaluation, fir~ 1000 ga!. DSF 245.00 i 20,00
<br /> Site ~valuation~ es, addL 500 i~al, DSF ....................... 75.01) , 20.00/m
<br /> ~6nslmction & R.~pa/r Permlte
<br /> Standard System le~ [hall !000 ga, L DSF 245,00 ! 10.00
<br /> $245,00 I $15 each a~ldL 500 &al, DSF 10.00
<br /> Capping Fill 415.00 I 10.00 , ....
<br />
<br /> Gray Water Waste Disposal Sump .................... 120.00 i 10.00
<br />l-[oI(]ii~g Ta!}~ 245.00 ' I0.00
<br />Pressure Distribution 350.00 10,00
<br />Redundanl System -- 245.00 10.00
<br />Sand lviltex, .................. 44~.00 10,QQ
<br />Seepal~e 'I¥oi~ch ............... 245.00 , 10,00
<br />Steep Slope 245,00 10,00
<br />Tile Dewatefing System ............ 350,00 10.00
<br />Plan Revivw
<br />>600 gal. DSF,<I001 gaI, DSF 100,00 ~ ,00
<br />(For ea~h additional 500 i~a),~,,.pSF, 2~-00 ! .00
<br />Construction Pen-nit Ren0wal {Field Visits) 150.00 10,09,
<br />Authodzatton Notice (Field Visit) 150.00 ! 10,00 '
<br />Authorization Notice {No Field V..i,.~ ! ~) ..... 85-00 '"' '[':10.00
<br />Agnus] ~va!u~fion ~fLarge Sy~[¢m 90.00 i 10,00
<br />, P~mper,Tmck,,Inspectton~ ¥irst track 50.00 i .00. ......
<br />Pun per I rock Inlpeet on, ea. addl. rock 35.00 , ' ,00
<br />O~her
<br />
<br />(Mark if Applicalal* to this Application)
<br />( ) Te~t Holes am DuS
<br />( ) ! will call when Test Holes Dug
<br />
<br />(X) I ara pe r~bonhlg work on a propeCq, I own or occupy ) I am a regi~tored builder Or ( ) the authorized repre,mntative
<br /> ) 'Ibc work will be performed by a DEQ Licensed In,taller i
<br /> ) Other
<br />
<br />,Re$i{lential Single Family
<br />Site Evaluation. first lot - .,2.4,5.1)1),, 20.00
<br />.... Sitv Eval,uation: ca. ~dl. tot 205,00 20.00
<br />con~tm¢fion pe~t
<br />Smnda~ Syaem "~45.00 10.00
<br />Capping Fill 41~,00 10.00
<br />Disoo~l Trench in Sao~ ' 245.00 10,00
<br />Gray W~r Dispo~l Sump ~2~:~,9 ~0,~
<br />Holdin~ Tank , ....... 245.00 10-00
<br />Pros~u~ Distribution 350.00 ...... I~,,QO
<br />~dundant 245.00 10.00
<br />Sand Fitter ~45.00 ' 10.00
<br />St~e~ Slope 245.00 ,1,0-00
<br />Alte~ion 245.00 10.00
<br />Repair~ ~{or l{~,~field) 115.00 10,00
<br />~p~r~ ~nor (~nk} 75.00 10,00
<br />~nstmctton p~~jt Ren¢wal (Fie'la Visit) 150,00 10-0~ .......
<br />~onst~etlon Pe~it Renewal ~o.Fi~ld Visit) 85,00 10,00
<br />~inspectton Fee ,, ,, ,25,00 .00
<br />Authofi7mion Notice (Field Visit) lf0.00 10,00 ,,,,,, I
<br />Existing System Evaluaion 150,00 10~90
<br />...... ~,ual Evaluatio~Altematlv* Sy$t;'m 150.00 .00
<br />
<br /> Ru~ A~a Vafi~c~ ~ ~valu~oa 245,00 "~,00
<br />
<br /> · Receipt No.
<br />I agree to install aacording to the submitted plans and spe¢ificattons, the lava
<br />ofth~ Stat~ of Oreson and the ordinances of Marion County.
<br />
<br />NAME OF APPLICANT (please print):
<br />SI~N,~TIJRE OF APPLICANT:
<br />
<br />DATE:
<br />
<br />MC 15-SI REV 2/93
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