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f! .FOR CITY USE ONLY Received By: 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 373-4427 RECEIVED FAX 588-7948 EVALUATION AND/OR SEPTIC PERMIT APPLICA--J~IRION COUNTy l. LOCATION OF INSTALLATION ~"P~-C--~/~.SO tM ~ 0 ~ ~'~" qO 60-6/d - I LotW~d* /~D/ Lo, O.pe i,~/ ~r%qciO~XI//~ 2, CONTRACTOR INFORMATION Prolnmy Owner Auth. Agent/Leas~e Vs~ofS~o~r~ Oq I~b }4O'r~L No. Employees Private Well ( ) Spring Community Well ( ) City 3. FEES ** Fees include DEQ Surchargc ($30.00) Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea add] lot ...................................................................................................... 235.00 Site Evaluation, Conunercial, first 100) gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Vaxiance .............................................................................................................................. 320.00 Cons~'uction Permit or Commercial Major Repair, first 1000 gallons: Standard System ................................................................................................................................. 382.00 Aerobic System .................................................................................................................................. 218 Capping Fill System ........................................................................................................................... 593.00 Cesspool ............................................................................................................................................. 382,00 Disposal Trench in Saprolile .............................................................................................................. 382,00 Evapot~an spiration-Absorption System ............................................................................................. 218.00 Gray Water Disposal Sump ............................................................................................................... 190.00 Pressure Distribution System ............................................................................................................. 550.00 Redundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 Seepage Pit ......................................................................................................................................... 312.00 Seepage Trench .................................................................................................................................. 382.00 Steep Slope ......................................................................................................................................... 382.00 Tile Dewatefing System ..................................................................................................................... 550.00 Construction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee Cormnercial 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 (dralnfield) ........................................................................................................ 210.00 Residential or Commercial: Alterations .......................................................................................................................................... 378.00 Permit Renewal, Field Visit ............................................................................................................... 227.00 Pemdt Renewal, No Fie d V s t ............................................................. 115.00 Authorization, Field Visit .................................................................................................................. ~A7.00 Authorization, No Field Visit ............................................................................................................ 117 Existing System Evaluation ............................................................................................................... 247.00 Annual Evalundon/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 Mailing Address Phone No. Mailing Address Phone No. Mailing Address ~C~ ~ j /~ $ $100/500 gallons + $25/500 gallons + $251500 gallons Receipt:_ Name of Applicant (Please~ SM'~n~,.R;;°fReAvPgs~l'cant:(~..~-'~4"~Jff_-d' ,~,,/ Date: ~ Total: Test Holes Ready: Date Tank Pumped: Date Pumping Certification Attached: (Y) (N)