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FOR-'OFFICE.~__~LY
<br />Received By: ~
<br />Zoning Validation
<br />Date:
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />
<br />8:00 a,m, - 4:30 pm phone 588-5147
<br />Code-A-Phone 588-7904
<br /> FAX 588-7948
<br />
<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION
<br />1. Location of Installation ~ o.~ ?rA/'~
<br />
<br />2, Contractor Information
<br />
<br />Auth, AgengL~asee Mailing Add,ss: Phone No,
<br />Contm~to~"~usiness Name & Number Mallinl~".~itir~'ss: Phone No.
<br />DF~ Licen~d Contractor & No. Mailing Address: Phone No,
<br />
<br /> C~q'r cia! (DSF ~ Daily Sewage Flow)
<br /> Sit~ Evalua}i~g,~' first 1000 rial. DSF 24~.00 ~0.00
<br /> Site gvaluati0a, eS, addl, ~00 gal, DSF 752,00 20.00lin
<br /> Standa~ System mo~ than 1000 ~1. DSF:
<br /> DJ~)osal T~ehe$ in Sapmllte ~4~,00 10.00
<br /> P~sum Distribution 350-00 10,00
<br />
<br /> Steep $1op¢ 245.00 10,00
<br /> Tile Dewatefing System 350.00 10.00
<br />
<br /> >600 ~1. DSF, < 1001~1. DS~ 100.00 .00
<br />
<br />(For oaeh addJrio~a1500 gal. D$F 2~,00 ,00
<br />.... ~tj~tions 24fi,00 10.00
<br />g,pair, Mi~r 75.00 ' 10.o0
<br />Const~ctloa Pemit Renewal (Pield Vislt$) 150,00 10.00 ;,
<br />Construction pe~it Rgnc~al ~o Field ~isltq 85-00 10,00
<br />~istin8 Syswm Evaluation Report 1 $0.00 10.00
<br />
<br /> ~mper Track In~etion, ea. addl. track 35.00 .00
<br />
<br /> (~gk if Applicable to this Application) ) Test Holes a~ ~g
<br /> ) I will call when Test Holes ~g
<br />
<br />) I am performing work on a property I own or occupy
<br />) I am a registered builder or( ) the authorized repveaentative
<br />) q[~ne work will be performed by a DEQ Licensed Installer
<br />) Other
<br />
<br />MC 15-S[ REV 2/93
<br />
<br />Residential Sinele Familv
<br />$it¢ ~valuation~ first lot 245,00 20.00
<br />Site Evaluation, ea. addi. lot 205,00 20.00
<br />Construction permit ·
<br />Standard gyslgm 245.00 10,00
<br />Capping Fill 41~,00 10.00
<br />~ j¢pO,qal Trench in Sapmlito 245.00 lo.e0
<br />Gray Taler Disposal Sump 120,00 10,00
<br />Holdinff Tank, 245.00 I0,00
<br />Pressure Distribution 350,00 10,00
<br />Redundant 245,00 10,00
<br />Sand Filter 445.00 l 0,00
<br />Seepage Trcnch 245.00 10.00
<br />Steep Slope 245.00 10,00
<br />Til~ Dewatefing 3~0.00 10,00
<br />Alteration 245.00 10.00
<br />Repai6 Major (dtainfield) 115,00 10.00
<br />Repair, Minor (;ask) 75,00 I0.00
<br />Construction Permit Renewal (Field Visit) 150.00 10.00
<br />Construct 9n permit Renewal {No F e d V S t) $fi,00 10,00
<br />Ralnsp~tion Fee 25.00 .00
<br />Authorization Noti¢~ {Field Visit) 150,00 I0,00
<br />Authorization Notice (No Field Visit) 85.00 10.00
<br />Existing System Evaluation 150.00 10,00
<br />Annual EYaluation/Alt ~m ative System 150.00 .00
<br />Annual Evaluation/Temp. or Hardship MH 90,00 ,00
<br />Rural Area Variance Si~ Evaluation ,245.00 20.00
<br />
<br /> Tots,,
<br />
<br /> Receipt No,
<br />I a~ree to install according to thc submitted plan~ and specifications, the law~
<br />ofth~ 8~te of O~gon and th~ ordinances of~fion Count.
<br />
<br />NAME OF APPLICANT (please print):
<br />
<br />sIGNATI]~E '(~F ~'PFLqC ANT:
<br />
<br />
<br />
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