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Job Add.ss I ~.~' 2 ~ ~ ~ Subdivisi°n ~) ~.~. ~ x._. [ FOR CITY USE ONLY MARION COUNTY BUILDING IN~.S.~C~I ,ON~ ~?'~ 77~?~-"~ COMMUNITY DEVELOPMENT C~ ~..:~"( ~ ~ i ~ ~ ~ ~'~ ~ ~ ~ ~ ~ ~ [Recd By: ~- 285 Church St. NE - Room 13~ ~A,~~ ~ t ~ I ~ I ]Zoning Vali~tion: Salem,Oregon 97301l U! 8:00amM:30pm Phone 588-514~ ~ ~ , .~,~. ~ SITE EVALUATION AND/OR SEPTIC PE~IT ~~A~~~ 1. LOCATION OF INST~LATION ~~I~U I ID I ai,i , n,X, r · No. Use of S~c~ ~t ~ mo=k ~ No.~mp~oy~=~ ~ ~ Ex~fing No. Be~ms m, nge Acres Section I Township ~ Lot Width q (~ Lot Depth \~ (~ 2. CONTRACTOR INFORMATION Zone [ Map \~ Irreg. Lot Comer 7o° Proposed No. 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 Evapotranspiration-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 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 Name ofApplicant (Please Print): ~ Z~--.)ff~,~ ~q"'~ Signature of Applicant: /~ ~6ff'~.t MC 15-SI Rev8/95 t '/ t - - Date: /'q '~'-'~7 -~r Receipt: + $100/500 gallons + $25/500 gallons + $25/500 gallons Test Holes Ready: Tank Pumped: Date Date Pumping Certification Attached: (Y) (N)