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Received By:
<br />Zoning Validation
<br />Date: ,,,
<br />
<br />MARION cOLrNTY BUILDING INSPECTION
<br /> 220 ltish Sa~et NE
<br /> Salem, OR 97301
<br />
<br />8:00 a.m. - 4:30 pm Phone $88-S 147 '~
<br />Code-A-Phone 58S-7904 ~j~ ~'~
<br />F.a~X 5S8-7948
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1. Location of Installation ~ ~-
<br />
<br />]obAddmss., ~ /O.. ~ ~'Z fid, ~*~. ,,. T~Acct,~o~&3 7S9-o~ CmssSt~et..
<br />Subdiv SiOn ~ ~] ~ ~ ~ ~e" ~ ~ ~ ~ O ~t ~/~lock Nc. Employees - *B'
<br /> . ,, , ..... g~. i~;~~- ~
<br />Mobile Home Park , , Space ~
<br />
<br />2, C, gntractor Infi}rmat[0n
<br />
<br />Commercial' (DsF - Daily ~va~e l*10w'~ I ~
<br />site l~valu~tipn, first 1000 fei, DSF 245.00 gO-00
<br />glt~ E~aluatlo~ ~,~,,~dl, 500 gal D$~, 75,00 20,00lin
<br />S~nda~ SyS~ffi mo~ than 1000 ~. DSF:
<br />CappinsFill 415.06 10,00
<br />,.~i{posal Tmnch'~'s ta Sapml/te 24fi.~0 10,00
<br />Pressure D~t~buti0n 350,00 10.00
<br />~aad Filter 4~5.00 10,~0
<br />Kut~o6~to~ ~ otle¢ ~Fi~14 Visit) 150~0 10.00
<br />Autho~zatio~.Notlco ~No Field Vis,t) ..... ~5.0.010.00
<br />,.~nnual Evaluat,~pn of Alternative System 150.00 10.00
<br />
<br />(Ma~if Applicable to this Applit~ation)
<br /> I/5"l'esl Holes are Dug
<br /> ) I will gall when Test Holes Dug
<br />
<br />) I am a m~iater~d builder or ( ) th~ authorized representative
<br />) O~hcr
<br />
<br /> Resid~ntial,,$inele Family, ,,~
<br /> Site Ev~luation~ first lot 24~.00 20.00 ~.~. ~"-
<br /> Si~: Evaluation~ ea. addl, lot , 205,00 20,00
<br />
<br />..... Standard Syst.~m ,,, 245,00 10,00
<br />
<br />...... ]4to]dJl~f4 Tank , 24~,.00 10,00 ,,,
<br /> ~ressum Distribution 350.{)0 10.00
<br /> Til~ Dewatefing 350.00 10.00
<br /> Alteration 24~,00 10.0q,,
<br /> Repair, Ma{~t (dminfield) 115,00 ,10.00
<br /> l~pair, Minor {task} 7~,00 10.00
<br /> Coastm~ti0n permit P~ugwa! {Fiji4 Visit) 1~0.00 ,10.00 ~
<br /> P. ueal Area Va~ae~ Site Bval~io¢. I 245,00 20,0~)
<br />
<br />I agree to ii, stall according 0 thc mhraltted plaas and ,qp**tfig~tFoas,'flle
<br />of the State of O~gon and the ordinances of Marion County.
<br />
<br />NAME OF APPLICANT (plea~print):
<br />
<br /> OF AP LIC ,rr:
<br />
<br />MC 15-8[ REV 2/93
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