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. FOR CITY USE ONLY R¢.c~vcd By: f~ 0,~ Zoning Validation'_ ~ ~ Date: q' ~ COMMUmrY DEVElOPMENt c~t, rrER 285 Ch~h S[ m- R~m 132 II S~ O~gon 97301 ~ ---- ~ ~ARION COUNTY SITE EVALUATION AND/OR SEPTIC PERMIT APPLICAT[~]~DING INSPECTION 1. LOCATION OF INSTALLATION Subdivision Lot ~s~ Block ~t, ~ No. E~loy~ S~on ~/ To~ip /~ ~ ~ ~e Map ~va~ Well ( ) Spring ( ~tWi~ ~/ LotD~ /~/ IA~s ~g. Lo~ Com~ 2. CONTRACTOR INFORMATION * * Fe~ include DEQ Sumhar~ ($30.00) Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ca addl lot ...................................................................................................... 235.00 Site EvaluaQon, Commercial, first 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural ~ Variance .............................................................................................................................. 320.00 Constm~'ton 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 Evapotranspiration-Ab~orption System ............................................................................................. 218 Gray Water Disposal Sump ............................................................................................................... 190.00 Pressure Distn'bntion Systexa ............................................................................................................. 553.00 Redtm0ant Syste~ ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 Seepage Pit ......................................................................................................................................... 312.00 Se~. Ttench.....2 ............................................................................................................................ 382.00 Steep $inpo ......................................................................................................................................... 382.00 Tile l~watering System ..................................................................................................................... 550.00 Construction Fercall or Commemial Major R~palr, over 1000 gallons: Conslxuction Permit Fee Commemial Plan Review 600 gallons - 1000 gallons ............................................................................................................... 133.00 1000 gallons - 2500 galloas ............................................................................................................... 133.00 Commercial Minor Repair ............................................................................................................................................... 173.00 Single Family Dwelling, Minor R~pair (tank oaly} ......................................................................................................... 130.00 Single Family Dwelling, Major Repair (drainfield} ........................................................................................................ 210.00 Residential or Co--iai: Allexations .......................................................................................................................................... 378.00 p~mit Renewal, Field Visit ............................................................................................................... 227.00 Pem~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 Temporaxy/Hardship Mobile Home .................................................................... 183.00 Annual Evaluation, Large System ..................................................................................................... 123.00 Pump or Dosing Siphon ....................................................................................................................... 25.00 Pumper Tn~k Inspection, First Vehicle ............................................................................................................................ 67.00 Pumper Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Reinspo~tion Fee ..................................................................................................................................................... 25.00 S~pfic Inspectioa for which no fee is specifically ind/cated .............................................................................................. 40.00/hr Recoipt: $ + $100/500 gallons + $25/500 gallons + $25/500 gallons Name Of Applicant (Pleas~ ~ Signature of Applicant: . Date: MC ISSl P-~ve/9$ FF t Test Holes Re y: Data Tank Puml~d: Pumping Certificatinn Attached: (Y) (lq)