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FOR CITY USE ONLY MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER ceived By:' ,~(.. 285 Church St. NE - Room 132 [~nin~ Validation: ~ Salem, Oregon 97301 ID ~ [~,.cj [ 8:00am-4:3Opm Phone 588-5147 ate: C~ (.. ? 24 hr. Inspection Line 588-7904 FAX 588-7948 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION 1. LOCATION OF INSTALLATION .... PrivaicW~il ( ) Spri.s' :2. CONTRACTOR INFORMATION Property Owner 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, lust 1000 gallons ............................................................................................................. 320.00 Site Evaluation, ~al i000:5000 gallons ............................... ~ ........ ~ .......... ~ ................................ 320.00 + $90/$00/gal ,.+.~1 ~fiL~.=00 gallons site ..valuation, .............................................................................................................................. 3 o.00 11)1 Construction Permit or Commercial Major Repair, first 1000 gallons: j ~-~ j [,~.~, ~,c~ s~ s~ ................................................................................................................................ 3s2.00 j Aerobic System .................................................................................................................. : .............. 218.00 I c~ing Fm S~m ............................................................................. : ............................ : ................ S~3.00 ~ ........ C~l .............. : .................................................................................................................. : ...... 3S200 PIAY ...... Di~x~al Trench in S~mlite .............................................................................................................. 382.00 ~~tion-^~tion sm~ ............................................................................................. 21s.00 MARION C-ray Water Disposal Sump ............................................................................................................... ~ ~,~i~.tion sy¢~ ............................................................................................................. ~3.oo Redundant Sym.-m ............................................................................................................................. 382.00 S~I Filt~ Symem ............................................................................................................................. 703.00 S~l~e Pit ...................................................................................................................................... .,.312.00 S~page Trench .................................................................................................................................. 382.00 Steep Slope ........................................................................................................................................ ;382.00 Tile I~wva~g Sy~x-m ..................................................................................................................... 550.00 Construction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee + $25/500 gallons Commercial Plan Review 600 gallons o 1000 gallons ............................................................................................................... 133.00 1000 gallons - 2500 gallons ............................................................................................................... 133.00 + {15/$00 gallons 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 ~uthorization, 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 .............................................................................................. 40.00Par -' Name of ^pplicant (Please ~ ~d~ ~ Test Holes Ready: Signature of ^pplicant: Date: "' . MC 15-SI Rev 8/95 Pumping Certification