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Received By: __ IZoning Validation: {Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 3150 Lancaste~ Dr. NE- Suite C Salem, Oregon 97305 8:00am4:30pm Phone 588-$147 24 hr. Inspection Line 373-4427 FAX ~88-7948 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION 1. LOCATION OF INSTALLATION 2. CONTRACTOR INFORMATION Mailing Address Ph~me No. Mailing Address Phone No. Mailing Address Phone No. 3. FEES ** Fees include DEQ Surcharge ($~0.00) Site Evnluatinn~ Single Family Dwelling, firsllot ......................................................................................................... $320.00 Site Evalua~on, Single Family Dwalling, ea addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation. Rural Area Va~nnce .............................................................................................................................. 320.00 Construction Permit or Commercial Major Repair, first 1000 gallons: Standard System ................................................................................................................................. 382.00 Ae~bie System .................................................................................................................................. 218.00 Capping Fdl System ........................................................................................................................... 593.00 C~sspooi ............................................................................................................................................. 382.00 Disposal T~h iu Sapmlite .............................................................................................................. 382,00 Bvlqx~sph~afion-Ab~orl~ion System ............................................................................................. 218.00 C~ay Water Disp~sl Sump ............................................................................................................... 1 Pressure Disuibmlon System ............................................................................................................. $50.00 R~dundlmt System ............................................................................................................................. 382.00 Sand Filter Syst~n ............................................................................................................................. 703.00 Seepnge Fit ......................................................................................................................................... 312.00 S~epnge "l~uch .................................................................................................................................. 382.00 Steep Slope ......................................................................................................................................... 382.00 Tile DewateHng System ..................................................................................................................... 550.00 ConsUuctiou P~t o~ Comme~ial Majo~ Repair, over 1000 gallons: Construction Pexmit Fee Conwaea-cial Plan Review 600 gallons - 1000 gailon~ ............................................................................................................... 133.00 1000 gallons - 2500 gallons ............................................................................................................... 133.00 Commercial Mi~or Repair ............................................................................................................................................... 173.00 Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 Single Family Dwelling, Major Rep~r (dminfield) ........................................................................................................ 210~00 Residential or Commercial: Alterations .......................................................................................................................................... 378.00 Permit Renewal, Field Visit ............................................................................................................... 227.00 Permit Renewal No Field Visit ...................................................................................................... ! 1 $.00 Authorization, Field Visit .................................................................................................................. 247.00 Au~horizailon, No Field Visit ............................................................................................................ 117.00 ~.~isting System Evaluation ............................................................................................................... 247.00 Annual Evahation/Altemailve System .............................................................................................. 2~7.00 Annual Evaluation Temporary/Hardslfip Mobile Home .................................................................... 183.00 Annual Evaluation, Large System ..................................................................................................... 123.00 Pump or Dosing Siphon ....................................................................................................................... 25.00 Pumper Track Inspection, FL~t Vehiele " ............................................................................................ 67.00 Pumper Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Reinspecilon Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee i~ specifically indicnt~l .............................................................................................. 40.00/hr + $100/500 gallons + $251500 gallons + $251500 gallons Name of Applicant (Fieaae Print): ~ L. Siglmure of Applicant: Test Holes Ready: Tank Pumped: Pumping Certification Attached: (Y) (N)