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FOR OFFICE
<br />Received By: ~rl~,
<br />Zoning Valida.~tion. ~. '~
<br />Date: 'l '
<br />
<br />MARION COUNTY BUILDING INSPECTIO
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<br /> $:00 a.m. - 4:30 pm Phone 5gS-$147 MARION
<br />
<br /> SiTE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1. Location of Instalhtlon Ct + NeE. Aurora 9?002
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<br />2. CoJltraetor lnfOrmatio~
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<br />J £ropertyO-,vner NO Corltrac[or · , ;,, , ,
<br />G~t~t~ Busiue~ N~ A ~u~ ~iliug Add,ss: Pkon~ No.
<br />DEQ Licensed ~nt~r & No. ~iling Add,ss: Phone
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<br />commercial (DSF ~ Daily ~ewate Flow) "' $
<br />......Site Evaluation, first 1000 ga.l. DSF ~'45.0~ : 20.00
<br />site :l~y~)~ation~ ea. addl. 500 F~al, D,SF 75,00 20.00/m
<br />Standard System I/ss than,,~900 ~al, DSF 245,00 : 10,00
<br />Standard System more than 1000 ~al. DSF:
<br />$245,00 + $15 each ad.dj. 500 8aL DSF 10.00
<br />Capping Fill 415.00 10,00
<br />Disposa[ Trenched. itt Saprolite 245,00 : 10,00
<br />Gm? Wa~er Waste Disposal Su. mp 120,00 : 10,00
<br />Holdin~ Tank 24100 : I0,00
<br /> P~s~ure Distribution 350,00, 10.00
<br /> Redundant System 24:5.00 : 10.00
<br /> Sand Filtei' ,, ~4~,OO ' I0.O0
<br /> Seepage Trench 245.00 10.00
<br /> S!~ep Slope .... 245.00 ,, i 10,00
<br /> 'File D.g~yatefing System 350.00 10.00
<br /> Finn l~view
<br /> >600 gal, DSF,<,I901 ~al, DSF 100.0,0
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<br /> (For ,~.ach additional 500 gal. DSF 25,00 .00
<br /> Alterat,Jons 245.00 !,,~0,00
<br /> Rcpaiq Minot .... 75,00 ; Iq,,00
<br /> Construction Permit P~ n.~?al (Field Vlsi{s) 150.00 ! I0-00
<br /> Cons!motion P.p,rmit Renewal 0qq,,l~ield Visits) ,8100 11070
<br /> Existing System ~val~ation Proper 1 $0.00,, ' 10.00
<br /> Authorization Notice (Field V.,i~i0 150-00 ; I0.00
<br /> Authorization Notice ~.? Field Visit) 85.00 ' } 10.00
<br /> Annual ]~va{ualion of Alternatlve System 150.00 ! 10.00
<br />..... Annual l~valu&tio,n o£Large~ystom ..... 90.00 : 10.00
<br /> Pumper Track Igsp¢,t on, First tmpk ,
<br /> Pllmper True,k Ynspection, ca. ndcll, t~¢k 35.00 : ..90
<br /> ,,;Other
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<br />(Mark if Apglleabie to this Application)
<br />0<) Test H°les are DuB !~/
<br />( ) I will call when Test Holes Dug
<br />
<br />) I am poffo~ing work on a pmpe~y I own or oeoupy
<br />)lamaregJsteredbailderdr( )theauthodzedmp~sen~ive
<br />(~) ~e work win be peffomed by a D~ Li¢en~d InsUlite
<br />( ) Other
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<br /> Residential Sih.le Family ' $,
<br /> Site Evaluation, first lot 245,00 ~q,00
<br /> Site EvalllatJo~aI e~ ~dl. lot 205,00 ,2Q,00
<br /> Disposal T~n~Sa~mlite 245,00 ~0,00
<br /> G~X Water Dispo~l Sump 120,00 10~00
<br /> Holding Tank ~45,00 10.00
<br /> Pgessu~ Di~tn~utlo~ 3~0,00 10.00
<br /> Redundant. 2,~00 10~00
<br /> ~nd Filter ~4~00', 10.00
<br /> Steep S ope ~ ~ 245.00 -
<br /> Tile ~watefin6 350.00 }0,00
<br /> Agemtioa 1~,245.~ 10.0~
<br /> ~pai% Ma{o~ (dminfield) I 1 $.q.0. I0.00
<br /> Repair, ~nor (rank). 75.00 10.00
<br /> Coastmefiou Pe~t ~newM {Fteld V~s'~i) ~50.00 .. 10.00 ....
<br /> Constmctiga Pe~lt ~newal ~o Field visit) 8~.00 10.00
<br /> Authorization Nptiee (Field Visit) . 150.00 10.00
<br /> Authorization Notice (No Field Visit) 85.0.~. 10.00
<br />_~iatlnfi $ys~m Evaluation .. 150.0o 10.00
<br /> Annual ~valua[io~Al~mat{vo S~m 150.00
<br /> Annual ~v~uatio~cmp. ? Ha~ship MH ~0,~ .00
<br /> ~ml A~a V~an,e Sit~ Evaluation, 245:90' 50.00
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<br /> Receipt NO.
<br />I agree to install aceo~inS to the submitted Finns and specifications, the law~
<br />of the State of Oregon and the o~inances of Marion Counly.
<br />
<br />NAME OF APPLICANT (please print): .
<br />SIGNATURE OF APPLICANT: DATE:
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<br />MC 15-SI REV 2/93
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