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~ FOR. CITY USE ONLY Received By: __ IZo~ng Validation: [Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St. NE - Room 132 Salem, Oregon 97301 $:00am-4:30pm Plume S8~-$147 24 br. Inspection Line 588.7904 FAX 588-7948 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION 1. LOCATION OF INSTALLATION 2. CONTRACTOR INFORMATION Mailing Address ~ / Phone No. e~..4~ ~_.- ** Fee~ inelud~ DEQ Su~harg¢ Site Evaluation, Single Family Dwelling, first lot ..................................................................................... .................... $325.00 Site Evaluation, Single Family Dwelling, ea addi lot ....................................................................................... Site Evaluation, Commercial, first 1000 gallo~s .......................................................................................... Site Evaluation, Commercial 1000 - 5000 gallons ....................................................................................... Site Evaluation, Rural Area Variance ............................................................. Construction Permit or Commercial Major Repair, first 1000 gallons: Standard System ......................................................................................................... Aerobic System ............................ Cesspool, Disposal Trench in Saprolite ............................................................ Evapotranspiration-Absorption System .................................................. Gray Water Disposal Sump .1' Holding Tank (Commemial only) $ gallons ................... 223.00 + $25/500 gallons + $251500 gallons ........... 387.00 .................... 387.00 ..... 387.00 Sand Filter System ............................................................. 708.00 Seepage Pit ............................................................... 7.00 Seepage Trench ................................................. 387.00 Steep Slope ......................................................................................................................................... 387.00 Tile Dewatedng System .................................................................................................................... :555.00 Construction Permit or Commercial Major Repair. over 1000 gallons: Construction Permit Fee Commercial Plan Review 600 gallons - I000 gallons ............................................................................................................... 133.00 1000 gallons - 5000 gallons ............................................................................................................... 133.00 Commercial Minor Repair ............................................................................................................................................... 178.00 Sthghi Family Dwelling, DEnor Repair (tank o~y) ......................................................................................................... 135.00 Single Family DweIling, Major Repair (dralnfield) ........................................................................................................ 215.00 Residential or Commercial: Alterations .......................................................................................................................................... 383.00 Permit Renewal, Field Visit ............................................................................................................... 232.00 Permit Renewal, No Field Visit ......................................................................................................... 120.00 Authorization, Field Visit .................................................................................................................. 252.00 Authorization, No Field Visit ............................................................................................................ 122.00 Existing System Evaluation ............................................................................................................... 252.00 Annual Evaluallon/Altemative System .............................................................................................. 252.00 Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 188.00 Annual Evaluation, Large System ..................................................................................................... 128.00 Pump or Dosing Siphon ....................................................................................................................... 25.00 Pumper Track Inspection, First Vehicle .......................................................................................................................... 102.00 Pumper Track Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic R~gnspaction Fee ..................................................................................................................................................... 25.00 S~ptie Inspection for which no fe~ is specifically indicated ........................... i .................................................................. 40.00/hr NameofApplicam(PleasePrint):~rt'C~ ~-~,~ ~ ~t~lt~{ Signature of Applicant: (~ ~'.~47~ Date: MC 15-SI Rev 1195 Total: Test Holes Ready: Date Tank Pumped: Pumping Certification Attached: (50 ON)