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Subdivision ~1 ~ ~f~f~'.~. ' ~t 7 Block
<br />~bil~ Home Park Soaee ~ ~
<br />~ction / [ To~shl;"""i 0 [ ~ng~ ] Zone ~ [ ~P
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<br /> Received By: J~' ,~-"' , ' ' 2'~0 HiShSt'met NE
<br /> Date: ~ 8.:~ ~m,. 4:30 pm Phew9 $88.5147 ,
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<br /> , BUILDING
<br /> Sl~ EV~UA~ON ~/ORS~IC PE~iT ~LICATION /
<br /> I. Location of Installation ~&LI ~d P~TD~o.~ I I I (
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<br />~.~ontractor Information
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<br /> Co~tor ~uslhoss Nm~ & ~b~r
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<br />3, Fees
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<br />Commercial/DSF- Daih, Sewage Flow'l
<br />$1to EvaluationI fi~ 1,000 ~al, D~F .245.00 20.00
<br />Site Evaluaion, e~ ~dl, 500 g~l. DSF 7~,;~0' 20.00/~'
<br />Construction & ~palr
<br />Standafl System leas than 1000 Oi~'"DsF
<br />S~ndard system mo~ than ~000 g~. DSF:
<br />$245.00 + $15 ~a~h addl, 500 ~I, DSF .... 10,00
<br />Capping Fi0 :415.00 ' 1~:90
<br />~oldlng T~k 24~,.00 .I0.00.
<br />,, Pt~ssU~ DislfibuSon : 350~,, 10;00
<br />,,,Redu~dgfl Sys~m ~.5,00 10,00
<br /> ,245.00 10,00
<br />.... S~patc Trench I ~'~,00 I0.00
<br />T}le Dewate~ng Sys~m 350.00 10,00
<br />Plan ~vi~w
<br />>600 gM. DSF.< 100~'~al, D~, 100~O .00
<br />Altemtions ...... ~4~.00 IQ.00
<br />Cons/nt~fion Pc~it Renewal (Field Vidts) 150,00 10,00
<br />..=Const~tion P~it Renewal,,(No F e d V s s) 85.00 10.00
<br />Authorization Notice (Field Visit),, 150.00 10,00
<br />Authod~ion, Nqtioc (No Field Visit) 86.00 ,,~0,-00
<br />A~nual ~wluafion o~ Altamative,,~yste~ 150,0Q 10,00
<br />Annual ~valuafio,n,,o~ ~e Sys~m 90,00 1Q,,00
<br />~mp~t Tmck},nagcctiou, Y mt track 50.00 ,,00
<br />~mpCrTmckIngp,ectioa~ea ~d track 35.00 / -06
<br />~har ,
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<br />(Mark ifApplkabl¢ to this Application) ) Test Holes a~ Dug
<br /> ) I will call when Test Holes Dug
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<br /> ) I am pcdonning work on a property I own or occupy
<br /> ) I am a mgistared buildet, gr ( ) the authorized rep~,~ntatiYe
<br /> Th~ work will be performed by a DEQ Licensed Installer
<br /> Other
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<br />Residential si~eJe F..amil¥ $
<br />Site !%aluation,..litst lot ! 245100 20.00
<br />: Site Ev~luaSon, ea add et ........ I 205.00 20.00 ..
<br />· Conitm¢fion pc..rlF, i~
<br />Holding Tan~.,; ,:,L 245;00 10:00
<br />_,~,dufida~t ' 24~00 10.00
<br />~a~ T~ch 24~.00 10,00
<br /> Steep Slope , 245.00 19-00
<br />Tita ~tefin~..., ~50.00 I0.00 ,
<br />Alteration ,~45.00 10.00
<br />~pairt Ma{o~ (dminfi~i~) 115.00 10,00
<br />Repair, ~nor (~nk).,. 75.00 10,00
<br />Constmctlon Po~t ~newal (Fta ~,V s t) 150.00 10,00
<br />~ins~e~tio~ F~o 25,00 .00 .....
<br />Authofi~fion Notice (Ftal~ Visit) 150.00 10.00
<br />Auihodzatloff Notice (No Field Vi,~it) 85,00': ' 10.00
<br />~istin~ 8ys~m Evalu~tio~ 150,00 I0,00
<br />Annual ByM?~tio~mp, or Ha~hip ~ 90,00 ,00
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<br /> P..c c c pt Ho,
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<br />of the State o~0t~gon and the ordinances o£ Mafior~ C<,unty
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<br />N~E OF A~PLIC~ (pleasg prin~
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<br />SIGNAT~E OF ~PLIC~: DATE;
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<br />MC 15-SI REV 2/93
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