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FOR OFFICE USE ONLY
<br />Received'By:
<br />ZoningValidation
<br />Date:
<br />
<br />MARION COUNTY BUII,DING INSPECTION
<br />220 High Street NE
<br /> Salem. OK97301
<br />
<br />8:00 a,m, - 4:30 pm Phoa* 588-S 147
<br /> Code-A-Phor,*
<br /> FAX 588-7948
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1, Location of In: tallation ,~,
<br />
<br /> Site NO, , ...... Use of Structure .........
<br />'Subdivision ~}ce ~ Block No. Employees
<br /> ...............
<br />~bil¢ Hom~ Park
<br />~fi~ ~ T~hip ~u~ moue ~ Map w t~sn
<br />
<br />2. C0q,~raetor Information
<br />
<br />Pmpeay Owner ' Mailing Address: Phone No,
<br />Auth. Asela/I,eas~e Mailing Add~: Phone No,
<br />
<br />Cont.~.ctor Buaia~ss Name & NumberI ~il{~g A~ss; ' ' Phou~ No. ' .......
<br />
<br />DEQ Licen~d Cont~Wr & No. ~millng Add,ss Phone No.
<br />
<br />iCom_mereial (DSF ~ ]bally Sewa~-~ Flow} ~
<br />,,Site Evatuafiou, first 1000 I~1, DaP ~45,00 20.DQ
<br />Site Evaluationr eS: addl. 500 gal, DSF 75,00 29,00/m
<br />Construction &,Re~air Permits
<br />Standard S~atem less than 1000 ~al, DSF 245,00 I0,00
<br />Standard System mos~ than 1000 pi:aL DS~,~
<br />$245,00 + $15 each addl, 500 gal, DSF 10,00
<br />Capph~6 Fill 415.00 10.00
<br />Disgo~l T~¢~c~ itx 8apmlite .... 245,00 t0.00
<br />Gray Water ~aste Disposal Sump ...... i,~9-00 I0.00 "
<br />._Holding Tank ........ ~45.00 , 10.00
<br />pressut~ Distribution 350.00 10,00
<br />_R_9.du ndan t System 245,00 10.00
<br />San0 FiJt~¢ 44~,90 10.00
<br />.$~pagc Trench ,, , 245.00 10.00
<br />~[~el) Slope 245.00 10.00
<br />Tile Dewat¢fi@~g System . , 350.90 10,00
<br />Plan Review
<br /> > d 00~.g.aI.,.D,SF, < 100 t"gaL DSF ......... [09,00 -90
<br />
<br />(For each,.~dditiona1500 gal. DSF 25.00 ~0
<br />Alterati~o p ~ 245,00 1.0.00
<br />RepalrI Mi.n,~,~ ,,, 75.00 I 0,,00
<br />Con~tmction Permit Renewal (Field Visits) 150.00 10,00
<br />Exlsfi r!g Sy St~m Eva~uatioll R~,poe, 150.o0 , I0.00
<br />Au/hodzatlon,Notiee (Field visit/, 150.00 10.00
<br />Autho,?,atio~ Notice {No Yield Visit) 85.00
<br />Annua~ gva, luatlon of Alteraatlve System 150,00 I0.00
<br />Annual Evaluatio,n of'Large System 91),00 10.00.
<br />Pumper Tru~k In,spevfion, First tree,k, 50 00 ,00
<br />Pumper Truck Yn~p¢ction, es, addl., track 35,00 .00
<br />
<br />(Mack if Applicable to Otis Application)
<br />
<br /> will call when 'l'e~t Holes Dug
<br />
<br />( )'lheworkwillhepedbrmodbyaDEQLicen~edI~staller
<br />( )
<br />
<br />Resldeniial $inele Familv ' $
<br />Site EvaluatlonI fi~t !et ,, , 245,00 20,0q,
<br />~onstmetion permit
<br />Standard System. 245.00 ..... ~0.00
<br />~jsposaiTroneh in Sapgollte , 245.00 10,00 ,,
<br />Q_ray Water Disposal Sump 120.00 10,00 ......
<br />Holding Tank 245~00 10,00
<br />pres~ut~ Dis!fibufioll 350.00 10.00
<br />Redundaut 24~.00 lq.P0
<br />Sand Filter .... 44~.00 ,,, 10.00
<br />Seepage Trench 24~,00 I0.00
<br />S_I~ ep Slol>e 245.00 10.1)0
<br />Tile Dewatefing 350.00 lO.Q9
<br />Alt*ration ,,, 24~,.00 10.00
<br />~3ir, Mmjor (dralnfield) - 115,00 I0.00 } ~C~
<br />Repair, Minor {tank) 75,00 10,00
<br />CoustrucfioE Permit Renewal ~F!eld Visit) 150,00 tO.O0
<br />,Co~s mc on Permit Renews G% Field,yis t) 85.00 19,00
<br />Reinspectlon Fee 25.00 ,00,,,
<br />.A, uthorization Noric~ (Field Visit),, 150.00 10.00
<br />Authorization Notipo (No Field Vlsi0, gS,0O 10.00
<br />Existing System Evaluatio~ 150.00, 10.00
<br />A. nnual Evaluatlon/Altematlve System 1 $0,00, ,0o
<br />Amlual Evaluafioll/Temp. o~ Hard~hlp MH 90,00 ,00
<br />Rural Area Variance Site Evaluation 245,00 20,00
<br />
<br /> R~ceipt No,
<br />I agrve to i to the submitted plans and specifications, th~ laws
<br />of the State of Or0gon and the ordinances o£Marion County.
<br />
<br />NAME,,O~F~ APPLI~CANT/9~I~ease print):
<br />SIGBIATURE OF APPLICANT: DATE:
<br />
<br />MC 15-SI REV 2/93
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