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'.'[FOR OFF~CcE~US~E/ONLY MAR]ON COUNTY BUILDING INSPECTION ;~
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<br /> SI~ EVALUATION ~D/OR SE~IC PE~ APPLICATION ~ARION COUNTY
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<br />2, Conlractor Infi)rmatlon
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<br />Amh, Agcnt/Leas¢~c~ Mailing Address: Phone No.
<br />Contractor Business Na..~m.~.,~,,NPmbe~ ................. Mailia~ Address: ................... "Phone No,
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<br /> Commercial (DSF-Daily S~wa$,~,,I?ow),,, Residential Single Family
<br /> Site Evaluation, first 1000 gal. DS...F. $ 200,IX g20,~ $~ Site Evaluation; f~st lot
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<br /> Stan~rd System less ~an 1~ ~]: DSF 2~.~ I0,~ S~nd~ System 2~.~ I0.(~
<br /> $tan~rd System m~e than 1~ ga~,p~: ,,, C~iag Fill 330;~ 10.~
<br /> Ca~ing Fill 330.~ 10,~ Gray Water Dia~al Sump ..... 95.~ 10,~
<br /> Gray Wat~{,Wm*~, Djs~sal sump 95.~ 10.~ ~eaa~e Dkffibuton ..... 280.~ 10.~
<br /> Pressure Distribution 280.~ 10.~ Sand Filt~ 3~,'~
<br /> Redundant System , . ........... 2~.~ 10.~ SeWage Trench ........ 2~.~ ~ .....
<br /> Seepage Trench ................ 2~.O 10.~ Tile ~wat~ng 280.~ 10.~
<br /> St~p Slope 2~.~ 10.~ ~terafion ......... 2~.~
<br /> ~1~ DewatefingSystem ....... 280.~ 10,~ Re~r, Maj~ (~eld) "'~5'.~ I0.~)
<br /> Pla~ Review Repair, ~nor (~nk) ............ (~,~ -~.~ .........
<br /> ~0 gal. DSE I~1 g~. D~,,, 80.~ .~ Construction ~e~t Ren~w~ ~ield Viht) ...... 120.~ 10,~
<br /> (exCept S~D FIIIERS) Cons~efi~¢' pemit Renew~ (No Field VisiQ 70,~ 10.~
<br /> For each additional 5~ g~. DSF 20.~ .~ ~, g~im~ion Fee 25.~,
<br /> Cons~tcfion Permit Renewal (Field Visit) 120,~ 10,~ Exiaing System Evalua~'~n ..... 120,~ 10.~
<br /> Cons~cfion Permit Rcnq,~,~ (No ~itld VisiB) 70,~ 10.~ ~Ann~l Evaluation/~ternaivc Sy~tc~ 120.~
<br /> E~fin~ System Evaluation ke~n ...... 120,% 10.~ Annual ~?Muafion/l~mp. or I-I~dahip ~,~, ~',~
<br /> Authorjr~Oon~iq~ (Fi01d Visit) ....... 120,~ 10.~ R~al ~ca V~gnc0 Site Evaluation 2~.~ 20,~
<br />Authoriz~IJonN~Jce~oFie~,yigt) 70.~ 10,~ ...... ,
<br />....~ al Evaluation of Alternative 8~,~?m 120.~ 10.~
<br />Annual Evaluation of ~,~,~,ys~m ...... 75.~ 10-~
<br />....~r Truck In~cfion First ~, 5~:,,~ -~ Receipt No,~
<br />Pum~r T~ck In~eefion, ea. Mdl. ~ek ,, , 35,~]
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<br />y~qif Applicable to this Application)
<br />( )'l¢st Hole. s are Dug
<br />( ) I will call when Test Ilole,~ Dug
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<br />I am Ix'gha-ming work on a property I own or occupy
<br />l am a rcgist,Jred builder ca- ( ) the authorized representative
<br />of a registered
<br />'Ille work will tx3, per,brined by it DEQ Licensed Installer
<br />Other
<br />I agree to install accord/ng to the subtnitted plans add
<br />Slxvcifications, the laws of IIIC~ State of Oregon anti the
<br />otdinance,s of Marion County.
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<br />t.. ~T'/ o F f+~o tz4~
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<br />.RE OF AppLICanT:
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<br />Mt: 15-74 RI~V 1/92
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