|
,"
<br />
<br /> · ~ ! CO MMUN1TY D[B/BLOPMBNT CENTER [[[ I~,~v-
<br /> Received By: --~l · - 2~ehur~W~. ~m~3z Ill.%c,'"' q~l
<br /> , Salem, Oreg°n 97301 ,,,, '~,,.~...,
<br />tZO'alQgVldida'tlOll: --~l : ' SEP 26
<br />
<br /> SITE I~.'.VALUATION -&ND/OR SEPTIC P~.RIVIIT .AppLIcJ~IP{~ COUNTY
<br />1. LOCA. TION OF INSTAI,LATIoN BUILDING INSPECTION
<br />Ko. , '.. _
<br />
<br /> iv,,, ,,i,,c .,..,
<br />2, coNTRAcToR INFORMATION
<br />
<br />3. FEES
<br />
<br /> ** P~e~ includ~ D~Q llur~ ($30.00)
<br /> Site Evaluatloa. ~iagin l~m~il), Dwallin$, first lot .................................................................................................... ~'-"~
<br /> . Sit/Eval0atlon Singl~ Famil~ Dv~lling, ee ~kll int ............ ~ .... ~.. .......... ............ ~ ................. L ~.:..... L ,..-~'~'~.~.~
<br /> Site Bvaluail~n, Comam'ctal, flr~ 1000 gailor, s ..................................................................... :. ................. 320100'
<br /> Site Even, Comm~wia11000 - 5000'~.llona .............................. ;. ......................... i ..................... 320 00 + $90/500/g/1 ' + $100/500 ~ailons
<br /> S te Evalualion, Rural A.~ea Varlam:e ............................................................ , ....................... 320,00
<br /> Constl'uctlon Pe~mi~ or Comme~fl Major Repair. first 1000 gailcns:
<br /> S~la~d System .......................................................................... ~ ..................................................... 382.00 .
<br /> Aembie Synton ...................... · ........................................................................................................... :218.00
<br /> .. Capping Fill System.... ................. · ................................ ~ .................................... ...................... ~, ....5~3.~
<br /> .Ceisli:iol ............................................................................................................................................ 382.uu
<br /> D/spos~l T/~ch in 5apro[ite...; ................................................................... L.......: ....... .~ ..... L'..3 8.~(~
<br /> -Eva~lza~k'a~l. At~o~/ion $1/~ em . , ........................................ ..::.. 218
<br /> c~:~ wmr I~i~e~ sump..... ............... : ....................... : .................. 7...L......:/,: .................. L...~.....i~0.00
<br /> Pressure Dism'bmion System ..................................................................................... 550.00
<br /> Redundaat System .............................................................................................................................. 382.00
<br /> ~ami'Fil~ $~tem ...................................................................................................... i ...................... 703.00
<br /> S eel~e Pit,, .................................................. .., .................................................................................. 312.00
<br /> 8~epage Trench ................................................................... ' ............................................................. 382./10
<br /> 8teel~ $1op~ ........................................................................................................... L{,.:;.g .......... L.....;382 00
<br /> Tile D~vate~ Sysiem ..................................................................................................................... 550.00
<br /> Consm.~ioJ~ l~rmit er Commercial Major Repak. over 1000/allons:
<br /> ,4: ..... ' Cons ~im ~ion Permit Fe~..~ $Z~/500 gallons
<br /> Commex¢ial Plan
<br /> 600 g~llons · 1000 gallons ........................................................... 13300
<br /> i000 ~allons -. 2500 ~llon~ .;....: .........................................................................
<br /> Comme~ia Minor Repa/r _ ~ , . 1 ?,~ r,,~
<br /> Smgl~ Family Dwalling Minor Repair 0a~k on y) ............................... 1~000
<br /> Sin/le Family Dwelling M~er Repair (dralnfie d) ........................................ ii, i~.iiiiiiii.....i" i.iii'ii"i i'"'"210'00
<br /> Resideptial or Commercial:
<br /> Altemio~s .................................................................................................................................. ....._378.00
<br /> Pc, stair Re~w.,I; l~ld Visit,.; ............................................................................................................ 227.00
<br /> Pem~ Ren~wa/ No Field Vhit .......................................................... '..'~ .; ,..,L.115~00
<br /> ~ Amhodza~ino. Field Visit .................................................................................... 24? 00
<br /> Au0~orizafion No Fm[d V sic ............................................................ 117 00
<br /> Existiri~ $~stam I/~,aha~inn ................................................................................ ;~....,.,...:.;...' ............ 247,00
<br /> An~al Evala~io~Alternaitve System. ............................................................................................. 24?.00
<br /> Aanual Ev,iduaflon Te~ora~/l..Iardsh/p Mobile Home ....................................................................
<br /> A~ual Evain?fiqn l.~r~z Sy~tera .................... . .............................. ;., ................. ; ........123 00
<br /> P?hip er Dos~ $iph0n ...._.:.........~ ................................................ '.,L'.,.,..i ................... 25 00
<br /> Pumper Tm¢l/Inspection. First Vehlile ........................................................................................................................... 67./]0
<br /> Pumper Truck Iaspection Ea Additional Vehicle .................................................................. 40.00
<br /> Septic R¢inspeefion Fee ........................................................ 2~.00
<br /> Septic Iaspoc6on for which no fee t~ sp~lficall.'/, ind caled ................................................. ~..,., ..........
<br />
<br />Signaturo of Appilca.tlt:~Date: ~
<br />
<br />Test Holes R~ady: _.~r- ~..z-q._.~
<br />
<br />Tank
<br /> Pumped: '
<br />
<br />Pumping Certi[ication At~ached: [Y) (N)
<br />
<br />
<br />
|