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4 ~F. OR C>ITY USE ONLY <br /> ~Rec¢ived By: __ <br /> IZoning Validation: <br /> IDate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:3Opm Phone 588.5147 <br /> 24 hr. lmpeelton Line 373.4427 <br /> FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION <br /> <br />Subdivision Lot Block No. Employees <br /> '21 <br />LotWidth i,~0/ ~v~e ~ ^~, ] Irreg.[o, Comet CommunityWell <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />3. FEES <br /> <br /> ** Fees include DEQ Surcharge ($30.00) <br /> Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.{30 <br /> Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 <br /> Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 <br /> Site Evaluation, Comraereial 1000 - 5~00 gallons .................................................................................... 320.00 + $90/500/gal <br /> Site Evaluation, Rural Area Variance .............................................................................................................................. 320,00 <br /> Construction Permit or Commercial Major Repair, first 1000 gallons: <br /> Standard System ................................................................................................................................. 382.00 <br /> Aerobic System .................................................................................................................................. 218.00 <br /> Capping Fill System ........................................................................................................................... 593.00 <br /> Cesspool ............................................................................................................................................. 382.00 <br /> Disposal Trench in Saprolite .............................................................................................................. 382.00 <br /> Evapntranspirntion-Ab sorption System ............................................................................................. 218.00 <br /> Gray Water Disposal Sump ............................................................................................................... 190.00 <br /> Pressure Distribution System ............................................................................................................. 550.00 <br /> Redundant System .................................................................................................................... ;........382.00 <br /> Sand Filter System ................................................................................................................... :.L......703.00 <br /> Seepage Pit ......................................................................................................................................... 312.00 <br /> Seepage Trench .................................................................................................................................. 382.00 <br /> Steep Slope ......................................................................................................................................... 382.00 <br /> Tile Dewatering System ..................................................................................................................... 550.00 <br /> ConsU'uetion Permit or Commercial Major Repair, over 1000 gallons: <br /> Construction permit Fee <br /> Comma. feint Plea Review <br /> 600 gallons - 1000 gallons ............................................................................................................... 133.00 <br /> 1000 gallo~s - 2500 gallons ............................................................................................................... 133.00 <br /> Commercial Minor Repair ............................................................................................................................................... 173.00 <br /> Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 <br /> Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 <br /> Residential or Commercial: <br /> Alterations .......................................................................................................................................... 378.00 <br /> Permit Renewal, Field Visit ............................................................................................................... 227.00 <br /> ~, Permit Renewal, No Field Visit ......................................................................................................... 115.00 <br /> ~nthoriaation, Field Visit ................................................................................................................. 2a~2.00 <br /> /' Authorization, No Fie d V sit ............................................................................................................ 1 i7.00 <br /> E~asting System Evaluation ............................................................................................................... 247.0(2, <br /> Annual Evaluation/Alternative System .............................................................................................. 247.00 <br /> Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183.00 <br /> Annual Evaluation, L~ge System ..................................................................................................... 123.00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br /> Pumpe~ Truck Inspection, First Vehicle ............................................................................................................................ 67.00 <br /> Pamper Truck Inspection, Ea Additional Yehinle ............................................................................................................. 40.00 <br /> Septic Reinspoction Fee ..................................................................................................................................................... 25.00 <br /> Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr <br /> <br />+ $1~0/500 gallons <br /> <br />+ $251500 gallons <br />+ $25/500 gallons <br /> <br /> Receipt:. <br /> <br />Name of Applicant (Please Print): <br />Sigaanti~ of Applicant: Date: <br />MC 15-SI Rev 8/96 <br /> <br />Test Holes Ready: <br /> <br />Tank Pumped: <br /> <br />Pumping Certification Attached: (Y) <br /> <br /> <br />