SESPEXIS - 1473743 - Laserfiche WebLink

Home Browse Search

· o I CENTER Received, By: I 285 Church SL NE - Room 132 Z~I~ll' Va, Ii} ' ; I Salem, Oregon 97301 g clarion: .[ 8:0~m4:30pm Phone $88-5147 ,Date: [ 24 hr' I ~n~ 'on588.LTined73"1427 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION 1. LOCATION OF INSTALLATION ' 2. CONTRACTOR INFORMATION Property Owner Auth. A~mt/Lea~¢~ Mailing Address Phone No. Mailing Addr~s Phone No. Address Phon~ No. 3. FEES ** Fees include DEQ Surcharge ($30,00) t I ~.~.. ~ C~il~ Site Evaluation, Single Famil ............. Site Evaluation. Single Family Dwelling, Site Evaluation, Commercial, first 10~0 .320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal + $100/500 gallons 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 Saprolite .............................................................................................................. 382.00 Evapotranspimtion-Absorpllon System ........................................................................ 218 00 Gray Water Disposal Sump ............................................................................................................... 190100 Pressure Di~ibufion System ............................................................................................................. 550.00 Redundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 S~pnge Fit ......................................................................................................................................... 312.00 Seepage Trench .................................................................................................................................. 382.00 Steep Slope ......................................................................................................................................... 382.00 Tile Dewatering System ..................................................................................................................... 550.00 Construction Permit or Conunerc~al Major Repair, over 1000 gallons: Constmetion Permit Fee + $25/500 gallons Commercial Plan Review 600 gallons - 1000 gallons ............................................................................................................... 133.00 1000 gallons - 2500 gallons ............................................................................................................... 13:}.00 + $251500 gallons Conunercial Minor Repair ................................................................................................... 173.00 Single Family Dwelling, Minor ~ only) ......................................................................... ~ ............. 130.00 Single Family Dwelling, Majo/~epalr (dralnfield) ................................................................ ~ .......... ~7~........210.00 Residemial or Commercial: Pemut Renewal, ~e ~...,..-~ .................................................................................................. 227.00 Permit Renewal No Fie d 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 Temporary/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 Reinspection Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr Name of Applicant (Piease Print): Sigeatut¢ of Applicant: MC 15-$I Rev Receipt:_ Test Holes Ready: Tank Pumped: Pumping Certification Attached: (y) (N)