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FOR CITY USE ONLY
<br />Received ny:
<br />Zoning Validatlon: ~ ~
<br />
<br />MARION COUNTY BUILDING
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<br /> 285 Church St. NE - Room 132
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<br /> 24 hr. l~pecfion Line 588-7904
<br /> FAX 588-7948
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<br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLIC~i~[N ~?JNT¥ f~-~[ ,.~oCq 7
<br />1. LOCATION OF INSTALLATION BklILDING I~¥S?Eg-£10N
<br />
<br />2. CONTRACTOR INFORMATION
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<br /> Mailing Address
<br />· ;: !. Mailing
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<br />Phone No.
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<br />Con~ra¢lor Business Name & Number ~jq~,(~,. -("
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<br />3. FEES
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<br /> Site Evaluation, Single Family Dwelling, first lot ............................................ ~ ............................................................ $325,00
<br />
<br /> Site Evaluation. Commercial 1000 - 5000 gallons ............................ ;..t~'~.~. t.---.- _ , ...................... 32S,00
<br /> SiteBvaluation, Rural Area Varlanee ................................................... -l--il,~l.g~T~c~l-ll-tl,I,.~..l~,~'~a~'~c,.~ ,.,/~. ................... 325.00 + $100/500 gallons
<br /> or Commercial Major Repair. first 1000
<br /> Construction
<br /> Permit
<br /> Standard System ll.t.lg,,Eq,,,,.. "'~ .P! t~ 111 I 3s700
<br /> Aero~ c Sys em .... JUl ............................. '~'"'i":[ 'T~'Vi'""' ,, '
<br /> Capping Fill Sy;~
<br /> Cesspoo ' .............. !"~t~"'~"i~'"'~'X2'Z'" 'F'r,'":T'"'-'~o '
<br /> D *posa Trench ~a Sapro ae .................................................................... ~....~ ........... J~,......387.00
<br /> Evapotranspiratlon,Absotption System ............................ ~,, ....................................................... 223.00
<br /> Gray Water Disposal Sump .... ,,,.....;.....-'~¥J/'~0~ D,tx~,v,,-_., I95 O0
<br /> Holding Tank (Commerc al only) .............
<br /> Prezsur¢ Distrlbut on System ': ..............
<br /> Reclundant System .........................................................
<br /> Saaa Filter Sys em ...................
<br /> Seepage P t ........ ............. .................................................. ....................
<br /> ................................................................... ; ............................. 317.00
<br /> Seepage Trench .................................................................................................................................. 387.00
<br /> Steep Slope ......................................................................................................................................... 387.00
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<br /> Construction Permit or Commemial Major Repair. over 1000 gallons:
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<br /> Commercial Plan Review
<br /> 600 gallons - 1000 gallom .__:..,....; ................................. i,-', ............................................................ 133.1)0
<br /> 1000 gallons - 5000 gallons ............................................... i. ................... ~. ......................................... 133.00
<br /> S'agle Fam ly Dwell?g, Minor Rejai; (tank o~'~'~ ............ iiiiiiiiiiiiiiiii ........................................................ ~'~
<br /> Single Family Dwelling, Major Repair (drainfield) ................................................
<br /> Resid~mtial or Commercial:
<br /> Alterations .............................................................. ............... ; ............................................................ 383.00
<br /> Permit Renews Fie d V s t ............................................................................. 232.00
<br /> Permit Renewal No F e d V s t 120 00
<br /> Authorization, Field Visit ........................................ , .................................................... 252.00
<br /> Authorization. No Field Visit ........................... ,. ............................................................ 122,00
<br />
<br /> Annual Evaluation Tempora,~ytFIardship Mob e Home...,,..' ............................................................ 18g.00
<br /> Annual Evaluation Large Sys em : ............................................... 128,00
<br /> Pump Or Dosing Siphon .........; ............................................. ;. .............................................................. 2S.00
<br />Pumper Truck Insp~fion. First Vehicle .................... ' 102
<br />Pumper Truek Inspection, Ea Additloaal Vehicle ' .......... : ............................................................ O0
<br /> ......... "' . ........................ 40.00
<br />
<br />Septic Inspection for which o fee ~ spec fica v nd cared ................................. S,00
<br /> ' .............................................................................................. 't0,00dir
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<br />+ $251500 gallons
<br />
<br />+ $25/500 gallons
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<br />Name pt Applicant (Please
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<br />Signature of Applicant: _
<br />
<br />MC 15-SI Rev 1/95
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<br />Test Holes Ready;
<br /> d-
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<br />Pumping Cer0fication Attached: (5') (N)
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