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/. FOR Cl~v US~ ONLY ~ MARION COUNTY BUILDING INSPECTION '4 _A [_I COMMUNITY DEVELOPMENT CENTER qRece~ved Bv' g ~~)~ 285 Chmh St. NE - Room 132 ~K~511 ] a' . ~' 'i I '1 Salem, O~gon97301 ~'~/~':~ /Z°ning Vali~~°n: ~'[ I 8:00am4:30pm Phone 588-5147 ~ ~*) l~ ~. ~~~ I 24hr. InspecfionLine588-79~ [,Y ~1~ SITE EVALUATION AND/OR SEPTIC PE~IT APPLICATIO~0~ 1, LOCATION OF INSTALLATION Sob^rialtos ~0%Og ~0o~ q?E Zax^cct.~4o.! C]OIClo0~0 Subdivision Section 13 Township Oq IRange Lot Width ~O ~. Lot Depth / O O F~' Acres 2. CONTRACTOR INFORMATION ltd i Irreg. Lot Comer Cross Street fl ~"~ ~, No. Employees Existing No. proposed No. Bedrooms / Bedrooms Water Supply: Private Well ( ) Spring Community Well ( ) City Property Owner Mailing Address Phone No. Auth. Agent/Leasee Mailing Address Phone No. Contractor Business Name & Number Mailing Address Phone No. 3. FEES ** Fees include DEQ Surcharge ($30.00) $ Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 Construction Permit or Commercial Major Repair, first 1000 gallons: Standard System ................................................................................................................................. 382.00 Aerobic System .................................................................................................................................. 218.00 Capping Fill System ........................................................................................................................... 593.00 Cesspool ............................................................................................................................................. 382.00 Disposal Trench in Saprolite .............................................................................................................. 382.00 Evapotranspimtion-Absorption System ............................................................................................. 218.00 Gray Water Disposal Sump ............................................................................................................... 190.00 Pressure Distribution System ............................................................................................................. 553.00 Redundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 Seepage Pit ......................................................................................................................................... 312.00 Seepage Trench .................................................................................................................................. 382.00 Steep Slope ......................................................................................................................................... 382.00 Tile Dewatering System ..................................................................................................................... 550.00 Construction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee Commercial Plan Review 600 gallons - 1000 gallons ............................................................................................................... 133.00 1000 gallons - 2500 gallons ............................................................................................................... 133.00 Commercial Minor Repair ............................................................................................................................................... 173.00 Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 Residential or Commercial: Alterations .......................................................................................................................................... 378.00 Permit Renewal, Field Visit ............................................................................................................... 227.00 Permit Renewal, No Field Visit ......................................................................................................... 115.00 v/Authorization, Field Visit .................................................................................................................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 Existing System Evaluation ............................................................................................................... 247.00 Annual Evaluation/Alternative System .............................................................................................. 247.00 Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183.00 Annual Evaluation, Large System ..................................................................................................... 123.00 Pump or Dosing Siphon ....................................................................................................................... 25.00 Pumper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 Pumper Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Reinspection Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr + $100/500 gallons + $25/500 gallons + $25/500 gallons tt .~ q 7. o'~ Name o f Applicant (Please Print): "~x~.~t-x?.-~r'~ ~'-~ ~ Signature of Applicant: MC 15-SI Rev 8/95 Date: Receipt: Test Holes Ready: ,Z4. Tank Pumped: ~ / ./~ Pumping Certification Attached: (Y) (N)