|
FOR OFFICE USE ONLY
<br />Received'By:~ ,
<br />Zoning Validation ~
<br />Date {'f~ -7~ -- ~/'t.J-
<br />
<br />MARION COUNTY BUiLDING INSPECTION
<br />
<br />8:00 a.m. - 4:30 pm Phone 588-5147
<br />Code-A.,Phone 588-7904
<br /> FAX 588-7948
<br />
<br /> SITE EVALUATION Ai~ ,/OR SEPTIC PERM_IT APPIelCATION
<br />1. Location of Installation C~Ld ~- ach~. ct.-/3 ~-t
<br />
<br />.,2t,_.~.0n t r ac t Or Information,
<br />
<br />tly Owner , , , Mailing Add.sm Phone No.
<br />Auth. Agcng'Lea:e Mailing Add~: Phone No,
<br />I CA2~ht2'or Bu~i~ ss Name & Number Mailing Add~s: : Phone No.
<br />D~ Licensed Continent & No. ~illn8 Add,ss: Phone No.
<br />
<br />Commereidi (OSF- Daily ~ewa~e Flow} $ ii,
<br />Site E¥aluation first 1000 gM. DSF 24~.b0 20.0q,
<br />Site Evalua6,~. ea. ~dl. 500 ~al. DSF 75.00 20,O0~m
<br />Construction & Repair,P¢~its
<br />Stan~?d System less than 1000 8al, DSF , 245,00 10,Q0
<br />Slan~ System mom tb~ 1000 gal, DSF:
<br />$245.00 '~' $1~,vach addl. ~00 gM, ~F 10,~0
<br />Capplng F}ll 41'$'.00 10-00
<br />, 245,00
<br />Pressu~ Distribution 350,00 10.00
<br />Redundant Syst*m 245.00 I0,00 .__
<br />~epage Trench . 24~,,00 10.00
<br />Steep ~lope,, , 245,00 10,00
<br />Plan R~v~0w
<br />>'600 gal. DSF.~I00I ~al. DSF '" 100.00 ,00
<br />
<br />~opalrr ~i~r ...... 7~.00 10,00
<br />.~onalm*tlon Pe~i[,~n~al (Fiold VisiLq) 150.00 1~.00
<br />Authorization Notice (Fi*~,d Visit) 1 $0.00 10,00
<br />
<br />(Marh ifApplleable to this Applioalion) ) Test Holes are Dug
<br /> ) I will call wher~ Tesl Holes Dug
<br />
<br />) I am perfonnlng work on a pwpeny I own or occupy
<br />) 1 am a reglslered builder or ( ) the authofiz, ed repr~s~ntatiye
<br />) 'lhe work will be pe~ornlod by a DEQ Licensed In,Miler
<br />) OIher
<br />
<br />MC 5-SI REV 2/93
<br />
<br />Residential'Sinele Familv
<br />Site Evaluationt fi~t lot 245,0p, 20.00
<br />Sill: Evaluation~ pa. ~Adl. lot 205.00 20.00
<br />Construction permit
<br />Standard System 245,00 10-90
<br />Capplng Fill 415.00 ,, 10,00
<br />~Di~oosal Trench in 8aprollt¢ 245,~}o .... 10.00
<br />G_ray Water Disposal Sump 120,00 10.00
<br />Holding Tank ,. 245.00 I0,00
<br />pressure Distfibu,[ion 350.00 I0.00
<br />Redundanl 245.00 10.0Q,
<br /> Sand Filter , 44~t00 10.00
<br /> Steep Slqpe 245,00 10.00
<br />
<br />,, Tile Dewatefinl~ 3 ~q,,00 I0.00
<br />Alteration , 245.00 .... 10.00
<br /> R~pa!r, Major (drainft~ld) 115.00 10,p0
<br /> Repair, Micor (rank) 75.00 10.00
<br /> Constmetiop Permit Pd:new=l (Fi*Id Visit) 1 $$.00
<br /> Constraetion,,Fermit R~newal {1,1,9 Field Vialt) ,,, PS.00 10.O0,,,
<br /> l~_i_nspcct]on F~e 25.00. ,00
<br /> Authofi:,~tiou Noti¢~ (F!,eld Visit) 150.00 10.00
<br /> Authorization Noti¢~ 0qo Iqeld Visit) 85.00 10.00
<br /> E _~i. sting Sgstem Evaluation 150.00 10,00
<br /> Annual ~valu olioldAItematlvo $~'s~m 150.00 ,00
<br /> A~nual E~aluation/T~mp. or H~rdship MH 90.00 ,00
<br /> l~t~ral Ar~a Vafi~ce Sit~ Evaluation ,, 245,00 20.00
<br />
<br /> Receipt
<br />
<br /> of the Stat~ of O£~gou at~d thc ordiuauc~s of ~on Couu~.
<br />
<br />~SIGNAT~ FLICk:
<br />
<br />
<br />
|