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MARION COUNTY BUILDING INSPEC
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<br /> fiatam. OR97301 JUN 0 1993
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />I, Location of Installation
<br />
<br />Contractor Information
<br />
<br />Auth. AgenVJ~a.~e ~ Mailing Address; Phone No.
<br />Contractor Busiaess'Narae'~"~umber Mali'i'ng Address: Phone No.
<br />DleX~ Licensed Contm~0tor & No, Mailing Afldr~ss: Phone No.
<br />
<br />Fees
<br />
<br /> Commercml (DSF = Dad~ Sewaoe Flow)
<br /> site Evaluation~ fit'at 1000 ga!.,,DSF 245,00 20.00
<br /> Site Evalg3ti~n'. ~a, ~ldl, 500 gal. D~,P 75.00 20.00lin
<br /> C0~,~tmctlo~ &:Repair Peimit~
<br /> Standard System le~* than 1000 $~!:,,,D.,~P 245.00 10.00
<br /> Standard System moi~ than 1000 gal,,I)~iz~ .............
<br /> $245~00 + $15 ca~h addl. ~90 gal, DSF 10,00
<br />CappingFdl 415.00 ,, 10~00
<br />Disposal Trenches, ia 8.apmlite 245,00: .10.00
<br />Gray Water Wasta D~sposM Sump 120.00 10.00
<br />Holding Tank 245.00 10,00
<br />Pressuxe Distribution 350.00 10,00
<br />Redundant System 24~00 10.00
<br />Sand Filtee 445.00 10.00
<br />$eegage T~neh 245.00 10.00
<br />.... ~taep Slope 245.00
<br />Tile Devtatedn~ System -- 350.00 10.00
<br />Plan Review
<br />.>6OO gal. DSF, <1001 gal. DSF 190.00 .00
<br />(For each MdRioaa1500 gal. DSF 25.00 .......
<br /> All,ions 245,.00 ...... 1,~0
<br /> g~egit,..~i.Opr ': 7S;0o ~0.00
<br /> Constmc0on Pe~it Rengwal,{Figld Vi~i/~) 150,9Q , 10,00
<br /> Construction Pg~ii Rgn~wal (No Ftald Visits) 85.00 10.00
<br /> F~is/ing System Evaluation ~poa 150.00 10.00
<br /> Au~h0fi~/o~ Notice {No ~i~ld ~isit) gl,00 10.00
<br /> Annual Evaluation ofAItgmaiive Syst!~ 150.00 10.00
<br /> Annual, Eg,~[~tion ofM~e Systam 90,00 10.00
<br /> ~mpe[,~mek Inspe~tioa~ Fimt track 50,00 .00
<br /> ~mper, Tmck Inspection, ea. ~d[. t~ck 35.00 .00
<br /> Oher
<br />
<br />(Mark i£Applicable to this Application) ~_ ~ .__ ~-~
<br />(~<~ Test ltotas at~ Dug
<br />
<br />~ I am pcffo~ng work on a pmpc~y I own or occupy
<br /> )[amamgistemdbaildor0r( )theautho~ed~p~n~tive
<br /> ) 'I~e work will be perfo~ed by a D~ Likened Installer
<br /> ) Other
<br />
<br />Residential Sinf,le Family
<br />Site l~valuation~ fimt lot 245,00 20.00
<br />Site Evaluatioth ea. add[. lot 205.00 20.00
<br />Standard System 245.00 10.00
<br />Capping Fail 415,00 10,00
<br />]] ~i,qp0~al Trench i~ S;Prolite ~4~-OO ~0.00
<br />Gray Wate~ Dispo,al,$~mp 120.0o 10.o0
<br />Holdtag Tank : . 245,00 10,00
<br />Pm,ssu. re,, D,is~rlhption ,;, 350,00 10-00
<br />Redundant 245.00 10.00
<br />Sand Filter : 445.00 10.00
<br />S~epage Treoch 245.00 10.00
<br />Steep Slop,e , , , 245.00 10.00
<br />Tile Dewatefinff 350,00 10,00
<br />Alteration 245.00 10.00
<br />~pair~ Maior (dmi~field) 115.00 I0.00
<br />Repair~ Minor (tank) 75~00 10-00
<br />Construction Pcnait Renewal (Fkl{l ¥isit) 150,00 10.00
<br /> Construction Permit Renewal (No Field Visit) 85.00 i6.06
<br /> ReinspeGtioa Fee 25.00 .00
<br /> Authofizat o~ Not cc (F e..,4,,,X(, s ,~~ ....... I i50~00 10~00
<br /> Authofi~atiOfi Notice (No Field Visit) 8~.o0 10,00
<br /> F~xistlnfi System I~valuatlon lB0.00 10.00
<br /> Annual Evaluatlon/A fiemative S~.t ~,m 150.00 .00
<br /> A~ual ~valuatlon/Temp, or Hardship MH 90,00 ,00
<br /> Rural Area Variance Site Evaluation 245.00 ~0':00
<br />
<br /> Total ~: I ~.
<br /> Receipt No.
<br />I acme to nste accent nS to file submitted plans and specifications, the laws
<br />of the State o£ Oregon aad~e ordinances of Marion County.
<br />
<br />DATE:
<br />
<br />MC 15-Si REV 2/93
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