SESPEXIS - 1455354 - Laserfiche WebLink

Home Browse Search

I~OR CITY USE ONLY Receiv.ed By: _ _ Zoning Validation: Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church SC NE - Room 132 Salem, Oregon 97301 8:00am-4:3Opm Phone 588-SI47 24 hr. Inspection Line 588-7904 FAX ~88-7948 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION 1. LOCATION OF INSTALLATION ~ I~Vt~_~ (-)g ~'? Usc of Sttuctu~ ~ Subdivision Lot Bilk No. Employes 2. CONTRACTOR INFORMATION Proper~y Owner Auth. Ag~ffLeas~e 3. FEES Mailing Address Phone No. Mailing Address Phone No. Mailing Address Phone No. Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commeigial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 Seepage Trench .................................................................................................................................. 382.00 Single Family Dwelling, Minor Repair (tank on]y) ......................................................................................................... 130.00 Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 Residential or Conunercial: Penn]t Renewal NO Field Visit ~/~,~.~..~.,~ ..................................................................... ~ lon, Field V~ ,,....._~...__ +$100/500gallo~ + $25/500 gallons + $25/500 gallons Receipt:. Total: Test Holes Ready: ~'~t.J~ I _ Tznk Pumped: Date: Pumping Certification Attach~i: O0 (lq)