i~OR.OFFICE USE ONLY MARION COUNTY B~D~G ~SPEC~ON ~ ~
<br /> Zoning vaiatio~ ~ ~,,~o~o~ ~ 0 ~ ]~<~ /~/''
<br /> Dat~: P_~ V~ ~ ~ g:00 m~ - 4:30 pm Phone 588-5147
<br /> ,, Code. A-Phone 588-79~ ~.--
<br /> ~ ~-~4~ ~iL'"?~O~'u,~vlN~ COu~,~,~ , r ·
<br />1. Location of Ins~ ~
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<br />SubdiviSion ~ffOff~ ~ ~t ']~ ~ Block
<br />
<br />tractor SnformatlO~ ~-. ,~ ,,'% ~
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<br />¢omlrRorcial (DSF -Daily Sewage Flow') S
<br />Site Evaluafion~ tint I000 8al, DSF 245.00 ..... 20.00
<br />~ite Evaluatig~I ea. addl, 500 ga~. DSF 75.00 20.00lin
<br />Const~Jon & ~pait Pe~its
<br />~nda~ S~?tem less than 100p ~a[, DSF 245,00 -~0,00
<br />Smndyd S~$~m mo~ ~ha~ 1000 ~1.
<br />$245.00 +$I$ ~ach ~dL 500 ~I. DSF 10,00
<br />C~pip~ F~ 4i5.oo lO,OO
<br />Disposal T~nch~ ~a Sa~li~ 245.90 10.00
<br />Omy W?er Waat~ Dispoml lump 120,00 10~00
<br />Holdin8 Tank 245~00 , 10.00
<br />PmssU~ Distfib~tiofi' 350,00
<br />Redundant $y~m 24~,00 1~,00
<br />$~nd Filt*r 445,00 10.00
<br />, ,Seepage T~enc~ 24~,00 10.~
<br />Steep SI9~e 245,00 10.00
<br />Til~ Dewa~fing System 350.00 10,00
<br />Plan R,view
<br />>600 ~al. DSP~<1001 ga},,~SF ..100,00 ' .00,
<br />
<br /> ,,(For ~h ~dRional, 500 gal D~F 25.00 ,oo
<br />
<br />Coaslmctlon P~it Ron*wal (dield,yisits) 150,0~,, 10,00
<br />Con,matron Pe~iI Renewal (No Field Visit} 85.~ 10,00
<br />~iating System Evaluation Repoa 150,00 10.0~,
<br />Authod~don Notice (Fiel~ Vis~t) 150.00 10.00
<br />A~thofi~tion Notiee,,~o Field Visit) ...... 85.00,
<br />Annual Evalaatio~ ofAltematiw Sys~m 150.0~ 10.00
<br />Annual Evaluation of~ System 90.00 ,10.00
<br />~mp~r Track Inspection. ~a, ~dl~ track , }5,00 .00
<br />Other
<br />
<br />(Mack if Applicable to this Appl}eatloa) ) Test Holes am Dug
<br /> ) I w/Il call when Test Holes Dus
<br />
<br /> i am perfornMng work on a property I own or occupy
<br />) I am a registered builder 0r ( ) the authorized lepreaentative
<br />The work will be performed by a DEQ Licensed Installer
<br />Olher
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<br />R%identj, al Singie Faintl~
<br />Site Evaluationt first lot ,~,~5.00 20.00
<br />Site l~valuationt ea. add]. lot ~ 205,00 20.00
<br />S~nd~ System ~ 5,00 ~
<br />Sand,hl~r ~5,00 IO,QO
<br />~*pag~ T~ch 24}.00 10.00
<br />R~pair~ ~or (dminfi¢ld),, ~15,00 10,00
<br />~ast~ct~on P~it R~no~l (~ield Visit) 150.00 10,00
<br />~onstmction P¢~it,~encwal ~o Field Vi~} 85.00 1900
<br />Autho~tioa Not{~ (Fi~id V~slt) 150.0~, 10.00
<br />Annual Ev~uati~emp, et HaMship M~ 90,00 30
<br />
<br /> logy o
<br /> Total
<br />
<br />of the S~ of O~gon and th~ offijnancea
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<br />NAME O_F APP~gI~ple~e/e(~tt~O~.,/
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<br />SIGNATURE OF APPLICANT: DATE:
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<br />MC 15-81 REV 2/93
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