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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 8:0~m-4:30pm Phone 588-5147 24 hr. Inspection Line 373-4427 FAX 588-7948 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION -Sub'risen -- ' ~ v Lot Block No. Employees Section ~ Township ~ Range t~ Zone Map Wat~rSupply: Pr[val~ Well ~ Spring ( ) LotWidthll,~, t~ Lo, Dclgh ..~ ~.3.~, Acres .~,~ Irrcg. Lo, Corner CommuhilyWell City / ) 2. CONTRACTOR INFORMATION Property owner Conh'actor Business Narn~ & Number Auth. Agcnt/Leasce Mailing Add.ss Phone No. Mailing Address Phone No. Mailing Address Phone No. 3. FEES ** F~s i~hidc DEQ Surcharge ($30.00) Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 Construction Permit or Commercial Major Repair, first 1000 gallons: Standard System ................................................................................................................................. 382.00 Aerobic System .................................................................................................................................. 218.00 Capping Fill System ........................................................................................................................... 593.00 Cesspool ............................................................................................................................................. 382.00 Disposal Trench in Saprollte .............................................................................................................. 382.00 Evapotranspiration-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 Dewatering System ..................................................................................................................... 550.00 Construction Pemdt or Coaunercial Major Repair, over 1000 gallons: Construction Pemdt Fee Commercial 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 on y) ................................................. 130.00 Single Family Dwelling, Major Repair (dralnfiald) ........................................................................................................ 210.00 Residential or Commercial: Alterations .......................................................................................................................................... 378.00 Permit Renewal, Field Visit ............................................................................................................... 227.00 Perm/t Renewal, No Field Visit ......................................................................................................... 115.00 Authorization, Field Visit .................................................................................................................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 Existing System Evaluation ............................................................................................................... 247.00 Annual Evaluation/Alternative System .............................................................................................. 247.00 Annual Evaluation Tempormy/Hardship Mobile Home ......................................................... 183.00 Annual Evaluation, Large System ..................................................................................................... 123,00 Pump or Dosing Siphon ....................................................................................................................... 25.00 Pumper Track Inspection, First Vehicle ............................................................................................................................ 67.00 Pumper Track Inspection. Ea Additional Vehicle ............................................................................................................. 40.00 Septic Reinspaction Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr + $I00/500 gallons + $251500 gallons + $251500 gallons Name o f Applicant (Please Print): ~_~ I'~, '~'~,~_I Date: Total: Test Holes Ready: Date Tank Pumped: Date Pumping Ce~ificafion Attached: (Y) (N)