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]FOR OFFICE 'USE ONLY
<br />Received By:
<br />Zoning Validation
<br />Da~e:
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />220 High ~4wet NE
<br /> Saler~ OR 97301
<br />
<br /> 8:00 a.m. - 4:30 pm Phone 598-5147
<br /> Code-A-Phone 585-7904
<br /> FAX 58g-794g
<br />
<br />SITE EVALUATION A.ND/OR SEPTIC PERlVIIT APPLICATION
<br />
<br />~cation of In?~ll~'tiost
<br />
<br />Property Owner Mallilqg Address: Phone No.
<br />Aufh. Agcnt/L~as~e~ Mallitlg Add~ss~ ~onc
<br />~ont~mr Basiaess N~mc & Number '" ~iling Addg~: "~onc No,
<br />DEQ~censed Cont~r&No. ~ ~gAdd~sa: ghoneNo,
<br />
<br /> Commercial (DgF
<br /> S to l~valuation~ first .1000 gal, DSF ,245'00 20.00
<br /> Site Evaluationt ea. addl, 500 gal. DAF ..... 75,00 20.OO/m
<br /> Collstmctlon 8: Repair Permits
<br /> Sten.0ard System less than 1000 ~al. DAF 24~i00 10,00
<br /> Standalrl System more tha~ {.000 ~al, DSF:
<br /> $2~$ 00 + $15 ~a~h addl. 590 gal, DSF 10,00
<br /> Gappiul~ Fill ,, 415,00 .... 10.00
<br /> Disposal .... Ti~eh~a in Saprolite ....... 245,00 10.00
<br />
<br />Holdlng Tank ....... 245,00 10.00
<br />Pressure,Distribution ..... ~$0,00 10.00
<br />Re undap~,,$ystem ,,~,g.$,00 I0.00
<br />Sand Filter 44S.00 10,00
<br />Seepag~ ~neh ........... 24~,0o 10,00
<br />,,,stseP Slope .......... 245,00 10,00
<br />Tile D~walq,tlnS System .~.$9.~9 10.00 " .I
<br /> Plan ~view ..........
<br /> {For o~h ad,d,i~ip2 al 500 gal DSF 2S.00 ...... ,~0
<br /> A]~e~$}o~ . ..... 245,00 10,00
<br /> P~psiFt Min°r ............ 75.oo 10.0o .........
<br /> E~0,pg System ~valu~ion ReFeR 150,.~_, 10,~
<br /> Aulhofi~tion ~otice (Field Visit) 150.00 10,00
<br /> Authod~tlon ~o,tle,~, ~o Field Visit) gf,00 10.~ ......
<br /> Aanaal Evaluation ofAItemglvo Sy~m 150.00 10.00
<br /> A~nual Evaluation of~e System ....... 90.00 10.00
<br /> P~E~,r Track Inspection~ Fire track ,~t~ .00
<br />
<br />(Mark if Applicable to this Application) ) Test Holes are ]Dug
<br /> ) I will call when Test Holes Dug
<br />
<br />) I am performing work on a pwpetW I own or occupy
<br />) I am a registered builder et( ) the authorized representative
<br />) The work will bg performed by a DF, Q Licensed Instiller
<br />) Oihcr
<br />
<br />Residential Sin~ie Family ' i $
<br />,, ~ite ~valualion, first lot ..... / 245.00 20.00 ~7/~
<br />Si~ IZvaluation~ ea. addl. lot 205.00 20.00
<br />Construction p~ ..re)it
<br /> Stand~rd System ....... 245.00 10,00
<br /> Cappin{g Fi{I ,4{~:~0 10,00
<br /> DJsno~al Trench in Sanrolit~ 245.00 lO.O0
<br /> ~ray Wate£ DispoSal Sump .... 120.00 10,00
<br /> Holdlng Tank , , 245.00 .... ~0,00
<br />Fi~ssure Distribution 350.00 ...... 10.00
<br />Redundant ...... 245.00, I0.00
<br />Sand Filter 445.00 10,00 ,,
<br />Seepage T~nch .......... 243-00 10,00 .......
<br />~tg,sp Slope ,2.~.5.00 10,00
<br />Tile D~wa~erinl! ........ 250.00 10,00 ........
<br />Alteration 245.00 10.00
<br />IO:~alt. Mate r (d ralnfleld) ll~rO0 ..... 10.00
<br />R~pair, Minor (tank) 75,00 10.00
<br />Construction Permit R~n¢~w~!,,(Ficld Visit) 150.00 10,00
<br />Co~$tmction,,P.~rmit Renewal 0'~o Field Visit) 85,00 1,9.~q .........
<br />P,~inspection Fee ......... ~5.00 .00
<br />Authorization Notice (Fidd Visit) ......... 150,00 10.00
<br />Authofizat on Notiq~,,~N..o,,,~jeld Visit) 85.00 10.00
<br />Existing System Evaluation ......... 150.00 10,00
<br /> Annual l~valuatloa/Alt em alive System 150.00 .......... ,00
<br /> An~ ~valuafion/Temp. or Hardship MH 90,00 ,00
<br /> Rural Area Variance Site Evaluation 243.00 20,00
<br />
<br /> Recalpt No.
<br />I agre~ to install according to thc submitted plans and specifications, the laws
<br />of thc Sta~ of Or~gon and the ordinances of Marion County.
<br />
<br />NAME OF APPLICANT (please print):
<br />SIGNATURE OF APPLICANT: DATE;
<br />
<br />MC IS-SI REV 2/93
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