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1~/15/96 09:47 9503 588 7948
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<br />003
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<br />MARION COUNTY BUILDING INSPECTION
<br /> COMMUNrrY DEVELOPMENT CENTER
<br /> 285 C~ch St~ ~ - Poem 132 .
<br /> 'Salem, O~ regOfi ~301
<br /> · 8t B0~n-4.'$0um Plmae $88-$14¥ ~
<br /> ** i;~ ~ss.~s'
<br /> SiTE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1. LOCATION OF INSTALLATION
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<br />- ]
<br />2, coNTRAcToR INFORMATION
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<br />[Malli~ A~e~ : · . Pho~e No.
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<br />Wat~ Supply:
<br />~omr~un.y w~u ~) ~ ty ( }
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<br />Si~ Evian, 5~g~ P~ Dwel~g, tint I~ ......................................................................................................... S3~.00
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<br />Si~ Ev~u~n, ~m~i~, fl~ 1~ ~ ......................... . ................................................... ;... ............................. 3~00
<br />Si~ E~i~, ~rei~ 1~ - 5~'g~lons ......................... ..,..'.,............~ ........... ~ .............. L,.,.....'.,320;~ + ~0/5~/gal ' + $1~5~ gallons
<br />Si~ E~on, R~g A~ V~ .................................................................................................... , ........................ 3~ 00
<br />Cons~ P~ or Co~ ~ R~. ~ 10~ ~llom:
<br /> S~ Sys~ .................... ~ ............................................. , ............................................................. 382.~ .
<br /> A~mb~ 8~ ................ ;.....; .......... i...... .......... ! ................. ;............' ................. ;...,...~..:....:.....,=...,..~218.~
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<br /> C~ ........................ , ............................... ~ ....................................... ~ .................. ' ................... L.L.382.~
<br /> D~ T~ m Sa~!i~ ............................................................................ ..,.....,..,.., .............. 38~ '
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<br /> ~ay Wa~ D~ S~p ...' ............... L ...:.....;....;.....:; .......... L ...,...~ ,~L....,. L..: ............................... I~.~
<br /> P~s~m Dis~bo~ Sy~m ........................................................................... · .................................. 5~.~
<br /> ~ $~ ........................................................................................................................... ;.382.00
<br /> S~ F~ ~ ................ ; .........i.i ........... .................. ; ~ 703,00 :
<br /> S~Pit ................................... ,.; .............. ............. ;..~;.~., .............. ; ............................................... 312.00
<br /> 8~ge ~ .................................................................................................................................. 382.00
<br /> S~p Slo~ ............................................................................................................ Lu.:;.~.2......;.~L ....::382~00 ' -
<br /> ~1~ ~w~g Sya~m ..................................................................................................................... 550.00
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<br />Co~u~ction P~r~t or Commercial Mgor Repair. over 1000 gallons:
<br /> · .~ ...... ,. :',C0nst~ction pe~,rmit ~ee.; +, $25/500 gailolxs
<br />Co--iai Plan R~vi=w
<br /> 6g0 ~film~s - 1000 gallons ......~ ........................................................................................................ 133
<br /> i000 ~all0~ -2500 gallons.; ........................................ · .......... L.......; .................. :.~:....L.~..:..:._....L...Itt.00 ~$25/500 gallons :, "
<br />Commercial Minor Repair ........................... ~;,..,.....: ...................... ; ................... ;,, ........................... i,;L..;a .................... ;173.00
<br />Single Family Dwelling, Minor R~palr (tank only) .......................................... ............................................................... 130.00
<br />S~ngle Family Dwelling, Mlgor Repair (drainfldd) ........................................................................................................ 210.00
<br />Residential or C~lxmercial: ; ; ' .r .~ '. :
<br /> i : !...~78.00 ' .:, .
<br /> .a,.l~a~o~s .................................................................... .. ............ ........................ ; ................. ,....,.
<br /> PP.J~A~ Re~ewal~ F~eld Vbi.~,.: ............................................................................................................ 227,00
<br /> Permh Renewal, No P~eld Ymt .................................................................................. ................. :..I.]5~00 ' '
<br /> Authmfzatlon. Field ¥i~h ................................................................................................................. 2~?,00
<br /> Authorif~tlon, ~o Fmld V~ait .......................................................................................................... ;1 i?.00
<br /> · ,'. Exla~n~gys~emEva3uatio~ .....................,.,.; ............. '_...,.,., ............ L.,....;,~;..;~...,,.,;;;,;,~.,_;,...247.00 ' , ' "
<br /> AnmJ~ Evahuaiou/AIM~Aa~vo -q y~t~n .............................................................................................. 2~7,00'
<br /> ~LDnual EvalUa.,l~n Tem~o[a~/]-]aJxtAhip MDbilo Home ....................................................................
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<br />Pum~e~ ?ruc~ ~lo~. ~x~(Vehi~]~...i ......... :.......: ......... ,.!....;...,_,..L.L...,.:...;...L.i;.L...L.i.;.L Z:,:, .......... ..:-.._67:0~)' '----'~--
<br />?un~uer Truck hapection, Ba Addi~onal Vehicle ............................................................................................................. 40.00
<br />~ep&ie R¢ins~on Fee ..................................................................................................................................................... 25.00
<br />8~fic IA~edou for which ~o fee ~ q~Acifical]y indical~ .......... . ........................................................................ ~........40.00/hr
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<br />Nam~ of Applicant (P]e, ase P'~nt): __
<br />Signature of Applicant:
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<br />R¢cei .pt:
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<br />__Date:
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<br />Teat Holes R~ady:
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<br />Tank Pumped: ,
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<br />Pumping Cea'fir']cation AtIachexi: (Y)
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