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FOil C'i'TY USE ONLY <br />l~eceivedByL __ _ _ <br />Zonil~gValidation: _ _ <br /> <br />Date: .... <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:3Opm Phone 588-5147 <br /> 24 hr. Inspection Line g88-7904 <br /> FAX S88-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION ~ t~.,q OR_. ~'7007_ <br /> <br />Township ~-- ~ ~ug~ } ~ 1 <br />I ~n* ~ ~ Map ] Water SUpply: <br /> <br />Lot~pm &l~.~~ A~ ]. ~0~ I~g,~t ~ Comer ~ CommunityWell ( ) City ( ) <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />Mailing Adcke~a <br /> <br />3. FEES <br /> <br /> Site Evaluation, Single Family Dwelling, ea m;tdl lot ...................................................................................................... 240,00 <br /> Sim Evaluation, Commercial. first I000 gallons ............................................................................................................ 325.00 <br /> Site gvaluafion, Commemial 1000 - 5000 gallons .......................................................................................................... 325.00 <br /> Site Evaluation, Rural Area Varitmee .............................................................................................................................. 325,00 <br /> Consm~etion Permit or Commercial Major Repair, first 1000 gallons: <br /> Standard System ................................................................................................................................. 387,00 <br /> <br /> Capping Fill System .......................................................................................................................... 598.00 <br /> Cesspool ............................................................................................................................................. 387.00 <br /> Disposal Treal 'ch in Supralife ..... 387 O0 <br /> Evapotranspirat[on-Ahso~ptlon System ........................................................................................... g23.00 <br /> Gray Water Disposal Sump ,...; .......................................................................... i ............................... 195,00 <br /> Holding Tank (Commemla only) 387 00 <br /> Pres*urc DisCdbutlon System ............................................................................ 555.00 <br /> Redundant Sysmm ....................................................................... 387 00 <br /> Sand Filter System ............................................................................ · .......... 708.00 <br /> <br /> Seepage Trench ....................... z ...................... 387 00 <br /> Steep Slope ........................................................................................................................................ 387.00 <br /> Tile Dewaterlng System ..................................................................................................................... 555,00 <br /> COnstruction Permit or Commercial Major Repair, over 10t~ gallons: <br /> <br /> Commercial Plan Review <br /> 600 gallons - 1000 gallons ............................................................................................................... 133.00 <br /> I000 gallons - 5000 gallons ............................................................................................................... 133,00 <br /> Commei~ial Minor Repair ............................................................................................................................................... 178.00 <br /> Single FamlIy Dwelling, Minor Repair (tank only) ......................................................................................... 135 00 <br /> Single Family Dwelling M~jor Repar (drainfie d) ...................................... 215.00 <br /> Residential or Commemiah <br /> <br /> Permit Renewal. Field Visit ............................................................................................................... 232.00 <br /> Permit Renewal, NO gi¢l¢l Visit ......................................................................................................... 120.00 <br /> <br /> AutholSzation. No l*leld Visit ............................................................................................................ 122.00 <br /> <br /> Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 188.00 <br /> Annual Evaluation, Large System ..................................................................................................... I28.00 <br /> lhlmp or Dosing Siphon ....................................................................................................................... 25.00 <br /> Pumper"D'uek Inspection. Fkst Vehicle .......................................................................................................................... 102.00 <br /> Pumper Trunk Inspection, Ea Additional Vehicle ............................................................................................................. 40,00 <br /> Septic Ralnspection Fee ..................................................................................................................................................... 2,5,00 <br /> Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br />+ $25/500 gallons <br /> <br /> Receipt:.__ <br /> <br /> , q/ .4 <br />MC 15-SI Rev 1195 ~ <br /> <br /> Total: <br /> <br />Test Hole~ Ready; <br /> <br />Tank Pumped: <br /> <br />Pumping Cel'dfieation Attached: (Y) (N) <br /> <br /> <br />