Laserfiche WebLink
MA RION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br />8:00 am- 4:30 pm Phone 588-5147 <br />Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEtrrIc PERMIT APPLICATION <br />1. Location of Installation <br /> <br />Subdivision ~ ~-~-~J'z~d~ ~ * -". '=~ /~ /~ ~Bi~k ~ <br />Mobile ~ome P~k JS~ee ~ <br /> <br />Contractor Information <br /> <br />/ M~li~n~ ,Address: <br /> Ma/ling AddresS: <br /> <br /> Phone No. <br /> <br />IPhone No, <br /> <br />Comm0rc~al (DSE-Da [~ewage Flow) <br /> <br />Sile Evaluafion~ dr.s*! 1000 gal. DSF <br />Site Evaluation, ea. addl, 500 gal. DSF <br /> <br />Standard Syil¢l¥1 less than 1000 gal, DSF <br />Standard System mc~-e than 1000 gal. DS?: <br /> <br /> $2(70,00. $15/each addl, 500 gal. DSF <br />Capping Fill <br />Disposal Trenchc..q ia Saprolite <br />Gray Water Wame Disl~sal Sump <br />Holding Tank <br /> <br />Sand Filter <br /> <br />Seepage 'B:qnch <br />Steep Slope <br /> <br />Tile Dewatering System <br />Plan Review <br /> <br />600 gal:, psE 1001 ~al. DSF <br /> (except SAND FILTERS) <br /> For each addhional 500 ga]. DSF <br /> <br />AJteradon~ <br />Repair, Minor <br />Construction Perntit Renewal (Field Vi.~it~) <br />Constmc0on Permh Renewal (No Field Visits) <br /> <br />E~xi~ng System Evaluafon Report <br />Authorization N~xice (Field Vim) <br /> <br />Authorization Notice (No Field Visit) <br />Annual Evaluation of Alternative System <br /> <br />Annual Evaluation of Larse Syntem <br />, Polllper True .k.,,lrt$1x~cfion, First truck <br />Pumper Track In][~dl, track <br /> <br />(Mark if ApplicabI4)o thls Application) <br />( ) Test 14ole.q ~e Dug <br />( ) I will call when 'lest Hole~ Dug <br /> <br />( ~am perfcn-ming work on a property I own of q~cupy ) I ara a registered bulkier c~ ( ) the authorized repre.~entadve <br /> of il regi.~tered btglder, <br /> ) 'D~¢ work will be performed by a I)EQ Licensed Installer <br /> ) ()thc,, <br /> ) I agree to m.¢lall ~ccording to the subnglted plans ami <br /> <br /> or{knancaq ct- Marion County, <br /> <br />/,.mount <br /> <br />Residential Sin <br /> <br /> <br />