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Received
<br />Zoning
<br />Date: ~
<br />
<br />l~dllON COUNTY BUILDING
<br /> 220 liigb Sir*et NE
<br />
<br /> 8:00 m~ - 4:30 pm ~one 58~-5147
<br /> Cod~-A-Phon~ 588-7904
<br />
<br /> Lot ~ Block ~ No. Emolovees v'~/'C4~,
<br />~objL, LYm0.rae Park Soace ~ ~o, I ~*' ~
<br />
<br />2. Coatractorlnforma~ion /
<br />
<br />P~opeay Owner ~/~/~ Mailing Address: Phone No,
<br />Auth. Agent/~a~e Mailing Addn:sa: Phone No,
<br />Contractor Business Name & Number ~__~ Mailing Address; .............. Phone No,
<br />DBQ Li~¢.se~ c~rd~tor & No., .... Mailing Address: Phone No.
<br />
<br />3. Fees
<br />
<br /> Commercial (DSF - Daily Sewaee Flow'~ $
<br /> $~te Bva!gu~io0, firsLl000 gel. DSF 245.00 20,00
<br /> Site Bvaluadon~ ea. addL 500 ~a!: DSF 75.00 20,00lin
<br /> Construction & Repair Permits
<br /> Standard System less than 1000 I~al. DSF 245,.0.q ............ 10,00
<br /> Standard Syat~ra more than 1000 l~al. DSF:
<br /> $245,00 ± $! ~ aaeh ~ddl. ~00 gal, DSF 10,00
<br /> Capping pill ]415.00 10.00
<br /> Disposal Tt,*nehes in Sapmlit~ 245.00 10.00
<br />,Gro~f,Water, Wa~,t?.Dispo,sgl Sump, , , ; 120.00 10.00
<br />Holdin8 Tank ' 245,00 1=0:00
<br />Prcssu{¢ Distribution 350,00
<br />Redundant System ' 245,00 10,00
<br />Sgod Fillet 4.4~,0,0, 10,00
<br />$¢epase Trench 245.00 I0.00
<br />S~eel~ Sio1>¢ 245,00 I0,00
<br />Tile D~watedng System ¥.0.00 I 0.00
<br />Pla0 Review
<br />>600 gal, DSF,< I001 Ra]. D~F 100,00 .00
<br />(For each additional 500 gal. DSF 2,~,,00 .00
<br />Repai6 Minor 75-00 10,00
<br />
<br /> Construction Permit R~ncwal (No Field Visits) ....... 1~5.00 10.00
<br />
<br />Authorization Notice (Field ylsit) , 1..5,9,:00 10.00 )~0,'~
<br />Authofizat on Not ce ~o,,~, e,,d, V a t) 85,00 10.00 .....
<br />Aaaua! Eyaluation of Alternative System 150,00 10,~0,,
<br />
<br /> Putnper Truck Inspection, First track .... 50.00 ,00
<br /> Pumper Truck Inspection~ ea. ad.d. J,...t ~c 35,00 .00
<br />Othe 0.X' frO,.
<br />
<br />(Mark if Applicabl~ to this Application) ) Test Holes are Dug
<br /> ) I wilI call when Test Holes Dug
<br />
<br />[ am performing work on a property I own or occupy
<br />1 am a registered builder or ( ) the authorized representative
<br />Th~ work will be pcdbrmed by a DEQ Licensed Installer
<br />Other
<br />
<br />Residential Sinele Familv $
<br />Site Evaluation~ first lot .......... ~45,00 20,00
<br />Site Evaluation, ea. addl. lot 205,00 20.00
<br />Construction permit ......
<br />~tondard Sys~m 245.00 10.00
<br />Capping Fill 415.00 10.00
<br />~Disoosal Trench in Savrolit¢ 245.00 I 0.00
<br />Gray Water Disposal Sump 120.00 10.o0
<br />Holding Tank ........ 245,00 10.00
<br />pressure Distribution 350.00 10.00
<br />.... Rqdundallt 245,00 ..... 10.00
<br />_.S.a.p,d, Filtar 445.0..0 .... 10.00
<br />S~epage Trench 245.00 ...... ~,0.00
<br />Steep Slppe ...... 245.00 10.00
<br />Tile IXowatering 350.00 10.00
<br />.... .A,l~ration 245.00 i0,00
<br />R. epaiq Major (drainfiel.d) 11~.00 10.00
<br />Repair, Minor{tank).., 75.00 10.00
<br />Constm¢tion Permit Renewal (Field V!,~,!~) 150.00 10.01) .....
<br />Co~stw¢tion Permit Renewal (No F.i.e I,d,Visit) $5,00 10.00
<br />l~inapection Fee ,,~,5,00 .00
<br />Authorization Notice (Field Visit) ....... 150.00 10,00
<br />AuthofiT~tior, Notice (No Field Visit) 8,$,.Q0 10,00
<br />Existing System Eva. l,~tion 150,00 ,1,O,00
<br />Annual ]~valuation/~ltemativ¢ System 150,00 ....
<br />Annual Evaluation~..e,l~p, Or Hardship MI,I 90,00 .00
<br /> Rural Area Variance Site Evaluatloa 245.00 20.0b '
<br />
<br /> l~ceipt No.
<br />I ague to install according to the submitted plans and specifications, the laws
<br />of the State of Oregon and the ordinances of Marion County.
<br />
<br />NAME OF APPLICANT (please print):
<br />SIGNATURE OF APPLICANT: DATE:
<br />
<br />MC 1S-SI REV 2/93
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