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FOR CITY USE ONLY <br />Received By: __ <br /> <br />Zoning Validation: <br /> <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br /> 8:~am-4:3Opm Phone 588-5147 <br /> 24 hr. lmpeeflon Line 3734427 <br /> FAX .~8-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />Mailing Adcl~ss Phone No. <br />Mailing Add. ss Phooe No. <br />Mailing Address Phone No. <br /> <br />** Fee~ include DF.Q Surcharge ($30.00) <br />Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 <br />Site Evaluation, Single Family Dwelling, ea addl lot....~ ................................................................................................. 235.00 <br />Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 <br />Site Evaination, ~ial 1000 - SO00 gallons .................................................................................... 320.00 + $90/SO0/gal <br />Site Evaluation, Runfl Area Variance .............................................................................................................................. 320.00 <br />Construction Permit or Commexcial Major Repair, first 1000 gallons: <br /> Standaifi System ................................................................................................................................. 382.00 <br /> Aerobic System .................................................................................................................................. 218.00 <br /> Capping Fill System ........................................................................................................................... 593.00 <br /> Cesspool ............................................................................................................................................. 382.00 <br /> Dispo~l T~nch in ~prolite .............................................................................................................. 382.00 <br /> Evapo~n-Abso~tlon System ............................................................................................. 218.00 <br /> G-my Water Dispozal Sump ............................................................................................................... 190.00 <br /> / Fressm'e Diz~ibufion System 550.00 <br /> Rodundant System ............................................................................................................................. 382.00 <br /> Sand Filter System ............................................................................................................................. 70~.00 <br /> S~Fag¢ Pit ......................................................................................................................................... 312.00 <br /> Scopnge Trench .................................................................................................................................. ~82.00 <br /> Steep Slope ......................................................................................................................................... 382.00 <br /> Tile Dewateving System ..................................................................................................................... 550.00 <br />Conslxucfion Permit or Commercial Major Repair, over 1000 gallons: <br /> Con~tmction Permit <br />Commercial Plan Review <br /> ~00 gallons - i000 gallons ............................................................................................................... 133.00 <br /> 1000 gallons - 2500 gallons .............................................................................................................. 133.00 <br />Commerdal Minor Repot ............................................................................................................................................... 173~00 <br />Singlo Family Dwelling, Minor Re,fir (tank ody) ......................................................................................................... 130.00 <br />Single Family Dwelling, Major Repair (drainfield) ............ : ........................................................................................... 210.00 <br />Residential of Commercial: <br /> Alternfions .......................................................................................................................................... 378.00 <br /> Permit Renewal, Fiald Visit ............................................................................................................... <br /> Permit P~newal, No Pi¢ld Vizit ......................................................................................................... 115.00 <br /> Authorization, Pield Visit .................................................................................................................. 247.00 <br /> Aufl~oriznfion, No Field Visit ............................................................................................................ 117.00 <br /> Existing Systom Evaluation ............................. : ............................................... ~ ................................. 247.00 <br /> Annual Evaluation/Alternative System .............................................................................................. 247.00 <br /> Annual Evaluation Tempec~,/H~lzh~p Mobile Home .................................................................... 183.00 <br /> Annual Evaluation, Large System ..................................................................................................... <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br />Pumper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 <br />Pmnper Tnw, k Inspection, ~ Additional Vehicle ............................................................................................................. 40.00 <br />Septic Reinspec4ion ~e ..................................................................................................................................................... 25.00 <br />~ Imi~fion for which no fee is specifically indicated .............................................................................................. 40~00/hr <br /> <br />+ $100/500 gallons <br /> <br />+ $251500 gallons <br />+ $~5/500 gallons <br /> <br /> Receipt:. Total: <br />Name of Applicant (piease Print): Test Holes Ready: ~ <br /> <br />MC IS-SI Rev8/96 Pumping Cetlifmafion Attached: (Y) (bO <br /> <br /> <br />