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FOR, OFFICE USE ONLY
<br />Received
<br />Zoning v~idaJi~rt ~
<br />Date: ~"!/] ~
<br />
<br /> MARION COUNTY BUILDING I~SPECTION ~ ,,... ~ .
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<br /> Code-A-Phoa* $88-7904 '
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<br />SITE EV~UA~ON ~/OR SEPTIC PE~IT ~PLICATIO~ ~ ~ ~ ~ ~ ~f~, ~
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<br />1. Location ofI~ ;tallation
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<br />2. Cent ractor/nforp~ afl[on
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<br />Auth. Agen~e ~ ~iling Add.ss: Phone No,
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<br /> _C31~ merc'ia'l'"~SF. Daily Sewage Flow)
<br /> Site Evaluation, first 1000 gal, DSF 245,00 20.00
<br /> Site Evaluation, es, addl, 500 i~tl. DSF ............ 75.00 20.00/m
<br /> , Co~,~[m,.ction & Repair Permit~ ,
<br /> StandaM System les~ than 1000 ~al, DSF .......... 2~,~:Q0 i0,00
<br /> Standard System mo~ than 1000 gal., I~S~: ...............
<br /> $245.00 + $15 each addl. 500 ~al, DSF 10-00
<br /> Capping Fill 415-00
<br /> Disposal Trenches in Sapmlite 245.00 , , ~0.,9,0 ......
<br /> Gray Water Waste Disposal Sump 120.00 10.00
<br /> ...Holdin8 Tank 245.00 10.00
<br /> Pressure Distribution 350.00 10.00
<br /> Redu nd,anL,S_v.a, tom 245.00 10.00
<br /> Sand Filter 445,00 I0.00
<br /> Seepage Trench 245.00 10,00
<br /> Steep Slope 245.00 10.00
<br /> Tile Dmtgriog.,S.v.q~c m 350,00 10,00
<br /> Plan Review
<br /> >600 gal, DSF,<I001 gal. DSF 100100 .00
<br /> (For each additional 500 gal. DSF 23,00 ,00
<br /> Alterations 245.00 10;00
<br /> Kepair, Minor 75,00 10,00
<br /> Constraetion permit Renewal (Field Visits) i50,00 10.00
<br />Consimctio~ Permit Renewal {No Field Visits) 85,00 10,00
<br />Existing System Bv~l~at~oa R~ort 150.00 10,00
<br />Aulhotizatlofl Nollce (Field Visit) 15(I.00 10.00
<br />Authorization Notice (No Field Visit) 85.00 10,00
<br />Annual Evaluation of Altcma0v¢ System 150.00 I0.00
<br />Annual Evaluation of Large System 90.00 10.00
<br />[ ,.~.u.E~£.~,r,Tmc8 Insp~¢tion~ First track 50.00 .00
<br />Pumper Track Inspection, ca. addl. track 35.00 .00
<br />Other ........
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<br />(Mark if Applicable to this Application)
<br />( ) T~St Holes a~e Dug
<br />( ) I will call when Test Holes Dug
<br />
<br /> ( ) i am performing work on a property I own or occupy
<br />( ,~l am a registered builder or ( ) the allthofized t~pt~sentative
<br />i (~) The work will be pcrfi~rmcd by a DEQ Licensed Inslaller.
<br /> ( ) Other
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<br />Residential Single Family $
<br />sit~ Evaluation, fi~t lot 243.00 20,00
<br />Site Evaluatlon~ em addl. lot 205.00 20.00
<br />Construction permit
<br />Standard System 243,00 10.00
<br />~ppinfl~![! 415.00 t0.00
<br />~iSp0eatl Trench in ,qapr01im 7~4~,00 10.00
<br />Gray Waler Disposal Sump 120.00 10.00
<br />Holding Tank 243.00 10,00
<br />Fress0,r~ D,ist,rib,uripn ............... 330,00 ,10,00
<br />Redundant 245,00 10.00
<br />Sand Filter 445,00 10,00
<br />Seepage Trench 245.00 10.00
<br />Stccp Slope 245.00 10.00
<br />Tile Dewatefin~ 350.00 I0,00
<br />Alteration 245,00 10.00 ,~,~. ~
<br />Repalr, Maior (d ralnfield) 115,00 10,00
<br />Repair, M/nor(tank) 75,00 10,00
<br />Construction F~rmit Renewal (Field Visit) 150,00 10,00
<br />Conswoctten Permit Renewal (No Field Visit) ~5~00 10,00
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<br /> Receipt No,
<br />I agree to instalI according to thc submlttcd plans and specifications, the taw~
<br />of the S~t* of Oregon and the ordinances of Marion County.
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<br />NAME OF APPLICANT (please print):
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