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FOR CITY USE ONLY Received B,y: __ Zoning Validation: [Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St. NE - Room 132 Salem, Oregon 97301 8:00am-4:30pm Phone 588-5147 24 hr. Inspection Line 588-7904 FAX ~88-7948 SiTE EVALUATiGN AND/OR SEPTIC PERMIT APPLICATION 1. LOCATION OF INSTALLATION 2. CONTRACTOR INFORMATION Mailing Address Mailing Add. ss Phone No. 7,~q-lOel~v Phone No. Phone No. 3. FEES ** F~s include DEQ Su~harge ($30.00) $ Site Evaluation, Single Finally Dwelling~ first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235 Site Evaluation, Commercial, lust 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/$00/gal + $100/500 salinns Site Evaluation, Rural Area Vminnc~ .............................................................................................................................. 320.00 Conslmction Permit or Commercial Major Repair, fn'st 1000 gallons: Standard System. ................................................................................................................................ 382.00 Aerobic System .................................................................................................................................. 218.00 Capping Fill System ........................................................................................................................... 593.00 Cesspool ............................................................................................................................................. 382.00 Disposal Trench in Saprolite ............ ~ ................................................................................................. 382.00 Evapotranspirafion-Absoq~tion System ............................................................................................. 218.00 Gray Water Disposal Sump ......................................................... ~ ................................................ ..... 1_L9_0~~ Pressure Distribution System ........................................................................................................ Redundafit System ............. : ......................................................................................................... Sa~ti Filter System ............................................................................................................................. 703.00 Seepage Fit ......................................................................................................................................... 31Z00 S~pege T~ench .............. : ................................................................................................................... 38:2.00 Steep Slope ......................................................................................................................................... 382.00 Tile Dewaterm~ System ..................................................................................................................... 550.00 Construction ?ernSt or Commercial Ma~or P~peir, o¥or [000 Constr~¢tion Permit Foe + $25/500 gellon~ Commeroiai Plan R~view 600 geilons - 1000 ~llom ............................................................................................................... 133.0~ 1000 sallons - 2~00 ~.llom ............................................................................................................... 133.00 + $25/500 gallon~ Commeroial Mino~ Repair ............................................................................................................................................... 173.00 Sin$1e Fa~ly Dv~11~, Mino~ Repair (tank on~y) ......................................................................................................... 130.00 Singl~ Family D~m~, Major ]~p~ (drain~¢ld) ........................................................................................................ ~ 1 P~s~den~l or Con~nerai~l: A~te~tion~ ............................................................................................................... ........................... 378.00 Permit I~ncwal, Field Visit ............................................................................................................... 227.00 Permit P~newal, No Fiolcl Visit ...................................................................................................... ...115.00 Au~otization, Field Visit .................................................................................................................. :247.00 Authorization, Ho Field Visit ............................................................................................................ 117.00 F.×istL~ System Evaluation ............................................................................................................... 247.00 A~n~fl ~v~luation/Altem~tive System .............................................................................................. 247.00 Anm~d Eval~tion Temp~rary,Thr&hip Mob~e Home .................................................................... !83 Ann~ EYa]uation, Large System ..................................................................................................... 1:23.00 P~mp or Do,in§ Siphon ....................................................................................................................... :25.00 I~nper Tr~k ir~p~tion, First Vehicle ............................................................................................................................ 67.00 Pumper Tr~ok Inspection, Ea Addition~] Vehiol¢ ............................................................................................................. 40.00 Septic R¢in~pection Fee ..................................................................................................................................................... 2~.00 Septic Inspection for which no fee ~s ~;cifioa]ly ~dicatad .............................................................................................. 40.00/hr ~0 Total: NameofApplieant(PleasePtint): Oon~ n la E. ,~ I~l ~ /icron l£, ,~. MC 15-$I RevS/95 Test Holes Ready: Tank Pmnl~d: _ Pumping Certification Attached: (Y) (lq)