|
MARION COUNTY BUILDING INSPECTION
<br /> 220 High Str~vt NI~
<br /> S~l~m, OR, 97~01
<br />
<br />8:00 nm.-4:30 pmPhone 588-5147
<br />Cede-A-Phone 588-7904
<br />FAX588-7948
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERI~IT APPLICATION
<br />i. Location of Installation ~ .1~ ~0,7
<br />
<br />ProDeRv Owner
<br />Subdivision ,,
<br />~~b~l* Home Park
<br />
<br />2, Contr.~tor Information
<br />
<br /> Commercial (DSF ~ Daily Sewa~-e Flow) I $
<br /> Site Evaluation. f~rst I QQ,p gal DSF 245,00 20.00
<br /> Sim Evaluation ga. ~dl. 500 ~al. DSF 75,00 20.00/m
<br /> Constmctlon & Rep~i~ Petite
<br /> S~aadard S~stem less than 1000 Ssi. DS~ 245.00 10.00
<br /> S~adard System mo~ th~ 1000 ~al. DSF: [",,
<br /> $245,09,,~ $15 Each ~dl. 500 gal D~,I ,, I0.00
<br />Cappia$ Fill ..... 415.00 10.00
<br />Disposal ~¢nch~ i~,, ~pmli~ 245.00 10.00
<br />Gray WaterWa~ Dispo~ Sump .... 120.00 ,,10.00
<br />Holding Tank 245.00 10,00
<br />,~ssu~* Distribution ~0.00 10.00
<br />~du~,~aut Sys~m 245.q9 I0.00
<br />~O, l;ilter ..... 445,00 1
<br />Seepage Tmnq,h 24~.00 10.00
<br />~ Slops 24,5.00 10,00
<br /> Tila D¢wat¢fing System ,~ ' ' 350.00 10.00
<br /> Plan ~view
<br />>o0~"~L ~s~,<.i0m aa mr ~d0.0o .00
<br />(e~D
<br />(For ~agh ad~,itioaa1500 gal DSF 25.~0 .00
<br />Alterations 245,00
<br />. ~onstmctloa Pemii REnewal (~ield Visits) ]50,00 10:q0
<br />Construction Pemit R*newal {Nq ~i~ld Visits) 8~.00 10.00
<br />~s6ng System Eval~~fioa RepoR 150,00 10,00
<br />Amhofization gotiee {Fiola ~sit) 150.00 10,00
<br />Aulhofization N,q~i~e ~o Field Visit) 85.00 10,00
<br />Annual Evaluatio~ 9fAItemative sy*gm 150,00 10.00
<br />Annual Evalua on of La~e,Sys~m 90.00 10.00
<br />Pumpqr Tmak Iaspe~tion~ Fi~ tmok 50,00 .00
<br />Pumpe[ ]Frock Inspection, es, ~dl. track 35,.,00 .00
<br />other
<br />
<br />(Mllrk if Applicable to this Applleafion) ) Test Holes ttl~ Dug
<br /> ) I will call when Test ltoles Dug
<br />
<br /> ) I am a mgister*d builder dr ( ) the authorized t'¢pn~sentetive
<br />~he work will be performed by a DI~Q Licensed Installer
<br />( ) Other
<br />
<br />Residential Single Family, 8.
<br />Site Eval~ation~ flint lot 245.00 ,~):90
<br />Site g'qg,19ation, ~*, addl. lot 205.00 ,, ,20.90
<br />Construction perrait .....
<br />Standa~ System 245.00 10.00
<br />Capplng Fill ., 415,00 10.00
<br />l~iapo~al Traneh in Sa~c~lite :~.45,00 10.00 ,, ,
<br />G~ay Water Disposal Sqmp 120.00 10,00
<br />Holdin~ Tank 245.00 I0.00
<br />P~ssur¢,,Distn'bution 350,00 t0.00
<br />Redundant 245.00 10.0q,
<br />Sand Filter 445.00 10.00
<br />S~epage Trench 2,45,00 10.00
<br />Repaitt Major (dminfi¢ld) 115.~00 I0,00
<br />R~pair, Minor (.i,ank) 75.00 10.00
<br />Construction Permit Renewal (Field ~r'i~it) 150,00 ,10,00
<br />Authorization,Notice (Fietd Visit) 150,00 lO,OO
<br />
<br />-- ~ural A~
<br />
<br /> Receipt No.
<br /> I agree to instil a*¢o~ing te the aubmk~d plans and ~eeifieations. th~ laws
<br /> of the S~ of O~gon and the o~inanc~s of ~fion County.
<br />
<br />MC 15-SI REV 2/93
<br />
<br />
<br />
|