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COMMUNITY D~VELOPMENT CENTER <br /> 285 Chumh St. NE- Room132 <br /> <br /> ~ hr. Inspecao~ L~ne 588-790~ <br />Date: <br /> 1 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />CONTRACTOR INFORMATION <br /> <br />Mailing Add.ss l Phone No. ] <br /> <br />3. FEES <br /> <br /> ** Fccs includ~ DEQ Surcharge $ <br /> Sit* Evaluation, Single Family Dwelling. first lot ......................................................................................................... $325.00 <br /> SRe Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 240.00 <br /> Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 325.00 <br /> Site EyaluaQon, Commercial 1000. 5000 gallons .......: .................... ~ ............. ; ............... ; ............................................... 325.00 <br /> Site J~-v:aluafion. Rural Area Variance ................................................ ,,...;..,.,.,;; ............................................................... 325,00 <br /> Constmotion Permit or Commercial Major P,~pair, flr~t I000 gallons; <br /> Standard System ................................................................................................................................. 397.00 <br /> Aerobic System .................................................................................................................................. 223,00 <br /> Capping Fill System ........................................................................................................................... 598.00 <br /> Cesspool ............................................................................................................................................. ~87,00 <br /> Di~p0Sal 'J~e~¢h i~ gap~olit~.....; ......... ;..',.;,,,.,,,,.,, ~ ......... 2 J..'.....,..L~2.....'..,.L,L; ................................ ,.387,00 <br /> ~vapotr~nspiraQon. Abso~tion System ............... ; ............ ;;.; ............................................................. 223,00 <br /> C-ray Water Disposal Sump ................................. ~ ................ ;...: ........................................... ~ ............ 195.00 <br /> I-Iolding Tank (¢ommcrcia! only) ......................... ............. :.: .................................. ........................... 387,00 <br /> Pressure Distribution System ............................................................................................................. 555.00 <br /> Redundant Syst:~m ............................................................................................................................. 387,00 <br /> <br /> Cor~raerciai MJno~ Repair .................................................................. , ............................ <br /> Single Family Dwelling, Minor Repair (tank ollly)..;..~ ...................... .....2.,,,,,.,.,....,. ............................. 135 00 <br /> Single Family Dwelling, Major Repair (drailLfield) ........................... ~ ............................................................................ 215.00 <br /> <br />Signature of Applicant: <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br /> <br />+ $251500 gallons <br /> <br />Test bloles Ready; <br /> <br /> <br />