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. mR.qTV vsE ONLY <br />Received By: __ <br /> <br />Zoning Validation: <br /> <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTE~R <br /> 285 Church St, NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 58g-S147 <br /> 24 hr+ Insl~ction Line g8s-7904 <br /> FAX 58g-794g <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION <br /> <br />2. CONTRACTOR INFORMATION <br />~o~y ow.~r F_~ <br /> <br />3. FEES <br /> <br /> S: e Evaluatmn, Commercial, first 1000 gallons ............................................................................................................. 325.00 <br /> Site EvaIuation, Commemia11000. 5000 gallons .......................................................................................................... 325,00 + $100/500 gallons <br /> <br /> Constraetioa Permit or Comme~ial Me(or Repair, first I000 gallons: <br /> Standa~ Sysmm ................................................................................................................................. 387.00 <br /> <br /> Capping Fill System ........................................................................................................................... 598.00 <br /> Cesspool ............................................................................................................................................. 387,00 <br /> <br /> Evapotranspiration,Abso~fion $ys~m ................................. ............................................................ 223.00 <br /> Gray Water Disposal $um~ ............................................................................................................... 195,00 <br /> Holding Tank (Comme~ial ouly) ...................................................................................................... ~87.00 <br /> <br /> R~undant Sys~m ............................................................................................................................. 387,00 <br /> <br /> S~p~e Pit ......................................................................................................................................... ~17.~ <br /> S~page Trench .................................................................................................................................. 387.00 <br /> <br /> Cons~etion Pe~t F~ + $,25/500 g~lons <br /> Commercial Pl~ Review <br /> 600 galloos - 1000 g~lons ............................................................................................................... 133.00 <br /> 1000 g~lons - 50~ gallons ............................................................................................................... 133,~ + $25/5~ gallons <br /> Come.iai Minor R~paff ............................................................................................................................................... 178,~ <br /> Singl~ ~amily Dwalling, Minor Ra~ir (tank only) ......................................................................................................... 135,00 <br /> $ing]o Family Dwalling, M~or g~pair (dminfield) ........................................................................................................ 215.00 <br /> Residential or Commewiak <br /> Alterahons .......................................................................................................................................... 383.00 <br /> P~it RonewaI, Field Visit ............................................................................................................... 232.00 <br /> Peemit Renewal, No Field Visi~ ......................................................................................................... 1~.~ <br /> Am~orizatlon, Field Visit .................................................................................................................. 252,00 <br /> Au~o~zatio~, No Field Visit ............................................................................................................ 1~.00 <br /> <br /> Annual Evaluation Tempot~Oi~hip Mobile Home .................................................................... 188.~ <br /> Annu~ Evaluatiom L~ge Sysmm ..................................................................................................... 128,00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br /> <br /> Septic Ralnspeegon F~ ..................................................................................................................................................... ~.00 <br /> Septic lnspeet~? for which no fee~ificall~ indicated .............................................................................................. 40.~mr <br /> ~//~~/ R~cipt,.. ~ Total: <br /> <br />Name of A~plicant (Pleas ~ T~st Holes Ready: .... <br /> <br />S[gaatu~ of Applleant; Date; Tank Pum~d: ........... <br /> <br /> <br />