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· ~o~ c, rrv ~Tq~lt~ v I MARION COUNTY BUILDING INSPECTION~ <br /> . ~ ............ ~ COMMUN~Y DEVELOPMENT CENTER ~ <br /> . . , ~ , ~ ~ Salem, Oregon 97301 <br /> <br /> ,- ~ ~1~ / 24hr Imp~UonLinc~88-79~ <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT <br />1, LOCATION OF INSTALLATION ~ ~ <br /> <br />~tWidth ~ LOtDepth ,~,0~ Acrca, {¢ I~cg,~t ~,g, Coenee ~,~, CommunltyWell () City ............ <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />3. FEES <br /> <br />Site gvaluatlon, Single Family Dwelling, first 10t ......................................................................................................... $325.00 <br />Sim Evaluation, Single Family Dwelling, ea acldl lot ...................................................................................................... 240.00 <br />Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 325.00 <br />Site Evaluntkm, Commercial 11300 - 5000 gallons .......................... ; ............ ; .................................................................. B25.00 <br />Site Evaluation, Rural Ama Variance ................................................ ,...~..~ ...................................................................... 325.00 <br />Constraetlon Permit or Commercial Major Repair, first 1000 gallons: <br />Standard System ................................................................................................................................. 387.00 <br />Aerobic System .................................................................................................................................. 223.00 <br /> Capping Fill System ............ : .............................................................................................................. 598.00 <br /> Cesspool ................................................................... ; ............. ........................................... ~ ................ 357.00 <br /> Disposal Tr~mch in Sapeolite ............. .,......:.:......,; .......... ................. .................................... ................ 387.00 <br /> Evapomm~piration-Absorpfi0n System ............................................................................................. 223,00 <br /> Gray Water DiSpoSal Sump ............................................................................................................... I95,00 <br /> Holding Tank (Comm~miaI only) ...................................................................................................... 387.00 <br /> Pressure Distribution System ............................................................................................................. 553.00 <br /> Redundant System ............................................................................................................................. 387.00 <br /> <br /> Seepage Trench .............................................. .................................................................................... $87,00 <br /> <br /> 600 gallons - 1000 gallons ............................................................................................................... 133.00 <br /> <br />Single Family Dwelling. Minor Repair (tank only) ...................................................................... i~ .......................... 13S 00 <br />$1ngl~ Family Dw~lling, Mai r Rcpa r (drainne d) ............................................................................ 2.22[[[[215[00 <br /> <br />Name of Applicant (Ptease Pti.t): <br /> <br />+ $1001500 gallons <br /> <br />+ $25/500 gallons <br /> <br />+ $251500 gallons <br /> <br />Date: <br /> <br />Test Holes Ready: __ <br /> <br />Tallk Pumped: <br /> <br />PumpingCe~'ification Attached: (Y) (N) <br /> <br /> <br />