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FOR OFF, ICE, USE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 Hiilh Street NE <br /> Sa em= OR 97301 <br /> <br />8::00 a m -4::30 p m Phone 588-5147 <br />Code-A-Phone 588.7904 <br /> FAX 588-7948 <br /> <br />FOR OFFICE USE ONLY <br /> <br /> DWELLING/STRUCTURAL~:~EEOEI .~EPTIC PERMIT APPLICATION <br /> <br />1. Job Description ~ ~ IIII <br /> <br /> ~A~/a.,- r I Addition [ ] Demo <br /> [ ]~ SrD ~/o sa~ [ ] ~aoo~ ~U~V 6'O~T~t~~ [ ] 0~ <br />~ Addition [ ] Demo 8UI[DING I <br />~. Location of Installation <br /> <br />3. Contractor Information <br /> <br />'~o~. -]gq- ~,_~J'~ 5. Fee Schedules <br /> <br /> ,C~nt~_o?,~iness_,,~_ / ~ Name&Numhee Mailing Address& PhoneNo <br /> <br /> Arg~;..z~ ]~l~ Mailing ,&ddl~ss & Phone No,, <br /> <br />4, Septic Information (Check where applicable) <br /> <br /> lest lloles Ready [] Will Call When q est Holes Ready [] <br /> <br />I'~¥ am peffOlllling work m a property I own Oe Oe. C0py <br /> Oth~r <br /> <br />agree to build according to the. submitted plans and specificatlorls, thc laws of <br /> <br />A New Onc-and-T,~o Family Dwelling Code Valuation: <br /> (incindcs I[1, Me, <br /> <br />(])Sq Ft x 28 <br />(2) 5% Stat~ Snr~,harge (,05 x A1 ) <br />(3) Bas~ Fee for Plan Restew <br />(4) Zoning Surcharge (If Applicable) <br /> <br />1850il <br /> <br />Subtotal:: <br /> <br />D <br /> <br />Structural Permg <br />(Permit fee determined by ,~aluatlor~ <br />El, Me, Pl am separate per'mit s,,) <br /> <br />(I) Permit Fee <br />(2) $% State Surcharge ( 05 x BI) <br />(3) Zoning Surcharge ( (15 x BI) ~/.~,l_~ <br />(4) Plan~ Check (65 x BI) _~_~_ <br /> Suhtotak $ <br /> <br />Septic Fees (l~clodes DEQ Surcharge) <br />(t) Site Evaluation <br />(2) New Septm Installation Permit <br />(3) At~thonzation Notice <br />(4) Existing System Report <br />(5) Major Repair <br /> Minor Repatr (tank onlT) <br /> <br />Valuation: <br /> <br />(1) Driveway wi curb (gq $750 <br />(2) Ddveway '&/o curb @ $1700 <br />(3) Sile Plan Re'~m,~ (commerc{al only) (t~ $79 tX) <br /> <br />(5) Reinapection Fee @ $25 O0 <br /> <br /> x $40 <br />Total; <br /> <br /> <br />