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FOR ciTY USE ONLY "' <br />IReceived,By: .-- <br /> Zqning ~Validation: <br /> <br />IDate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, erasers97301 <br /> 8:OOam-4:3Opm Phone 588-5147 <br /> 24 hr. Inspection Line $88-7904 <br /> FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION <br /> <br />Tax Acct. <br /> <br />Lot Depth Acres <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />Private Well ~ $[n'ing ( ) <br />Community Well ( ) City ( ) <br /> <br /> Standard System ................................................................................................................. ~'~.~7'?'?'?',"~I~O~¢~,~'~T"tMy;~%~,?'~. %~. O0 <br /> Aerobic System ............................................................................................... <br /> Can, ln~ Fill System .................................................................................... <br /> Cesspool ................................................................ '. ............................................................ ],11~I~.f~',.387,00 "~ ~ ~; ,' <br /> Disposal Trench in Saprolite .............................................................................................. ~,~.~.[....,..357,00 'r~ ~'~, -- <br /> Evapotranspiration-Absorption System ............................................................................. ~3k?:,.":,.....2~1, <br /> Gray Water Disposal Sump ............................................................................................................... <br /> Holding Tank (Commercial only) ...................................................................................................... 387,00 <br /> Pressure Distrlbutio~ System ............................................................ ................................................ ~[~0N 00ONTY <br /> R,xlundant System ........................................................................................................................... <br /> Sand Filter System <br /> · - ....................................... :,. ............................................................................ <br /> INSPECTION <br /> Seepage P,t .................................................... ...: ............................................................................. .:JI7.00 <br /> S¢¢pag~ Trench .................................................................................................................................. 387.00 <br /> $~ep Slope ......................................................................................................................................... 387,00 <br /> Tile Dewamfing Sy$~m ..................................................................................................................... 555.00 <br />Construction P~tmlt or Commercial Major Rcpalr, over I000 gallons: <br /> Construction Permit Fee + $25/500 gallons <br />Commercial Plan Review <br /> 600 gallons - 1000 galIons .............................................................................................................. 133,00 <br /> 1000 gallons - 5000 gallon~ ............................................................................................................... 133.00 + $25/500 gallons <br />Commercial Minor Repair ............................................................................................................................................... 178.00 <br />Single Family DweIling, Minor Repair (tank only) ......................................................................................................... 135.00 <br />Single Family Dwelling, Major Rep,dr (dminfield) ........................................................................................................ 215.00 <br />Residential or Commercial: <br /> Alterations ...................................................................... i ................................................................... 383,00 <br /> Permit Renewal, Field Visit ............................................................................................................... 232:00 <br /> Permit Renewal No Field Visit ......................................................................................................... 120.00 <br /> Authorization, Field Visit...; ............................................................................................................ 252.00 <br /> Authorization, NO Eield Visit ........................... 2 ................................................................................ 122,00 <br /> Existing Sys~m Evaluation ............................................................................................................... 252.00 <br /> Annual Evaluadon/Altematlve System .......................... : ................................................................... 25Z00 <br /> Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 188.00 <br /> Annual Evaluation, Large System ..................................................................................................... 128,00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br />Pamper Trtmk Inspection, First Vehicle .......................................................................................................................... 102,00 <br />Pumper Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 <br />Septic Reinspeotion Fee ..................................................................................................................................................... 25,00 <br />Septic Inspection lbr which no fee is specifically indicated .............................................................................................. 40.00/hr <br /> <br />Name of Applicant (Please Prin~T~ [~} <br />SignatureofAppliea~U ~ ~ V% ' ...... <br /> <br />Receipt:. <br /> <br />Test Hole~ Ready: ~ <br /> <br />Tank Pumped: <br /> <br />Pumping Certificatioo Attached: (Y) (N) <br /> <br /> <br />