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' [ DZ°2:g Validati°n: ~)~. , <br /> <br /> Salem, OR 97301· <br /> <br />8:00 am. 4:30 pm Phone 58g-5147 <br />FAX 588-7948 <br /> <br />SITE EVALUATION AND/OR SEPTIC COUNTY <br /> <br />2. Contractor Information <br /> <br />Proi~rty Owner Mailing Address; Phone No, <br />Auth. Ag~fit/L~asee Mailing Address: Phone No. <br />Contractor Busin.~, Name & Number .......... ! Mailing Addr~s: Phone No. <br />DEQ IJeensed Contractor & No. Mailing Addr~-~: Phone No. <br /> <br />Comme{eial (DSF-Daily Sewag~.,Flow) <br />S te F~valua 'onr fits 10~ Sal. DSF <br />Sito Evaluation, q~, odJdl, SO0 gal. DSF <br /> <br />, ConsU~¢tion & Repui[,p?{mita <br /> Standard System l~ss than 1000 gal. DSF <br /> Standard System rathe than 1000 gal. DSF: <br /> <br /> $200.00 + $15/each addL 500 gal. DSF <br />Capping Fill <br /> <br />Disposal Trenches in Saprolite <br />Gray Water Wante Dis~5! S~mp <br />Holding Tal~k <br /> <br />Redundant System <br />Sand Filter <br /> <br />$~epa~e Trends <br />Steep Slope <br /> <br />~le Dewaterln~ System <br />Plan Review <br /> <br />600 gal. DSE 1001..g.a/, DSP <br /> (except SAND F!LTERS) <br /> For each additioual $00 gal. DSF <br /> <br />Alteratlo~ <br />..R~pair,Minor <br />Construction Permit Renewal' (Field'Visits) <br /> <br />~~ Reaewal.(No Field Visits) <br />~stiag System Evaluation <br /> Au~ofization Notic~ (FieldS' win) <br /> <br />Authorization Notice (No Field Visit) <br /> <br />Annual Sv~]aation of Alternative System <br />Annual Evaluation of Large System <br />Purnper Truck Inspection. First mack <br />Pumper '!~lek Inp~e¢fion, ea. afldl, truck <br /> <br />(Mark ff Applicable to this Application) <br />· ( ) Test l-loles are Dug <br /> ( ) I will call when Test I,Iole.~ Dug <br /> <br />· ( ) I sin performing work on a property I own or occupy <br />( ) I am a registered builder c¢ ( ) the authorized repre~entetive <br /> of a registered builder. <br />( ) The work will be performed by a DEQ Licensed Installer <br />( ) Other <br />( ) I agree to install according to the submilt~ plans and <br /> ~pe~ificafions, the laws of the State of Oregon and the <br /> ordinance.~ of Marion County. <br /> <br />MC 15-74 REV 1/92 <br /> <br />Residential <br />Site Evaluation, first lot <br /> <br />Site Evaluation, ea. addl. lot <br />Construotion p~rmit <br />Standard System <br /> Pill <br />Disposal Trench in Sapro/ite <br />Gray W~t~r Disposal Sump <br />Holding Tank <br /> <br />Redundant <br />Sand Filter <br /> <br />Steep Slope <br />Tile Dewatefing <br />Alteration <br />Repair, Major (drail~ald) <br />Repair, Minor (tank) <br />Construction Permit Renewal (Field Visit) <br />Conswaction Permit l~newal (No Field Visit) <br /> <br />Authorization. Notice ~Field Vi~i0 <br />Authorization Notice (No field visit) <br /> <br />Existing Syntem Evaluation <br />Annual Evaluation/Alternaliw System <br /> ) MH <br /> <br />4- f/ Tr/ 17o '7W4 <br /> <br /> <br />