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'FOR CITY USE ONLY Zoning Validation: ~- MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St. NE - Room 132 Salem, Oregon 9730 l 8:00am4:3Opm Phone 588-5147 24 hr. Inspection Line 588-7904~t//'/ FAX $88-7948 [ I SITE EVALUATION AND/OR SEPTIC PERMIT 1. LOCATION OF INSTALLATION ?7'? } ~c.~ ~._ ! 2. CONTRACTOR INFORMATION Propervj O~ner Mailing Address Phone NO. Auth. Ag~nt/Leasee Mailing Address Phone No. Contractor Business Name & Number Mailing Address Phone No. 3. FEES ** Fe~s includ~ DEQ Surcharge ($30.00) Site Evaluation, Single Family Dwelling, tkst lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 Site Evaluation, Commemial, frost 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 Consti~cfion Permit or Cormnercial 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 Evapotr anspim~ion-Ab sorpfion System ............................................................................................. 218.00 Gray Water Disposal Sump ............................................................................................................... 190.00 Press~xe Distribution System ............................................................................................................. 553.00 Redundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 Seepage Pit ......................................................................................................................................... 312.00 Seepage Trench .................................................................................................................................. 382.00 St~, Slope ......................................................................................................................................... 382.00 Tile Dewatering System ..................................................................................................................... 550.00 Construction Permit or Coreanemial Major Repair, over 1000 gallo~s: Construction Permit 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 R~pair (tank only) ......................................................................................................... 130.00 Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 Residential or Con'anercial: AIt~rstions .......................................................................................................................................... 378.00 P~rmit Renewal, Field Visit ............................................................................................................... 227.00 Permit Renewal, No Field Visit ......................................................................................................... 115.00 Authorization, Field Visit .................................................................................................................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 Existing System Evaluation ............................................................................................................... 247.00 Annual Evaluation/Altemstive System .............................................................................................. 247.00 Atmual Evaluation Tempora~/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 Reinspostion Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr + $100/500 gallons + $25/500 gallons + $25/500 gallons Name of Applicant (Please Pfin~F~. ~ ~:~ Signsture of Applicant: /~-- ~ Test Holes Ready: 6/..~C~'/* ~> Ta~ Pmp~: ~ping C~fica~on A~ched: (~ ~)