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FOR CITY. USE ONLY ] MARION COUNTY BUILDING INSPECTION <br /> ' .~ ~ ~.~(/~n b COMMUNITY DEVELOPMENT CeNTER <br />~eceiv~o ~y: f~ ~ v~q~r ~ j 28S Church St. NH - R~m 132 <br /> . . , ~ - [ .... 2 ] Salem. O~gon 9730 [ <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATIO <br /> <br />Soh A~d~ a~O ~,~ qq ............... <br /> <br />8*~fion .... },5 Town~hip q5 ~ge [W~., Zone <br /> <br />2. CONTRACTOR INFORMATION <br />Pmp*~y Owner Mailing Addr*s$ Phone NO. <br /> <br /> ...~ite Evaluation. Single Family Dwelling. first lot ......................................................................................................... $325.00 <br /> Site Eva/uat on S nge Faro y Dwe ng Ga a0~ lo ........................................................................ 240.00 <br /> Site Evaluation, Comrae~'eial. first 1000 gaIIons ............................................................................................................. 325.00 <br /> git~ ~valuation~ Co~meeei~d 1000 - 5000 gallon~ ........... , ............................. 325,00 + $100/500 gallons <br /> $it¢ Evalaation, Rural At~a Valance .............................................................................................................................. 325.00 <br />.,.,..~onstmetion P~rmit or Commercial Major Repair, first I000 gallons: <br /> StandardSystern ................................................................................................................................. 387.00 r-./~ ~/~ <br /> Aerobic System .................................................................................................................................. 223.00 <br /> ~ :, Cal~ing Fill System ~ 598 00 <br /> ;, ,,~: c?ss~ool.,:..~.~ ......... :..,....;,~:,.:...~.......:....,.,.....:.....,.[.,.,_....~::~.:: .......... ;,,...:iZiiiii!iiiEZ~i~ 38, 0o <br /> D~sposal Trench i~ Sapro e ................................................................................... 387.00 <br /> Evapotranspi£ation-Absorption System ............................................................................................. 223.00 <br /> Gray Water Dhposal Sump ........................................................................................ 195 00 <br /> Holding Tank (Commercia on y) <br /> Presmr, Distribution System ............................................................................................................. 555.00 <br /> Redundant System ............................................................................................................................. <br /> Sand Filter System ............................................................................................................................. 708,00 <br /> ,*ggg$ ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :: :::::::::::::::::::::::::::::::::::::::: <br /> Steep Slope ................................................................ ~ ........................................................................ 387,00 <br /> Tile Dewat~ting System ..................................................................................................................... 555,00 <br /> Construction Permit or Commercial Major Repair. over 1000 gallons: <br /> <br /> Coastruction Permit Fee + $251500 gallons <br /> Commercial PIan Rovlew <br /> 600 gallons - I000 gallons ........................... , ............................................................ 133.00 <br /> I000 gallons - 5000 ga 0ns .......................................; ....................................................................... Igg,00 + $25/500 gallons <br /> ¢ommerelal Minor Repair ................................ <br /> S!ngle Fa ly Dweln.g. M .or Repot olli' 5 ........................ : ........... ............................................................ <br /> <br /> ,Resi~enfial or Commemlal: <br /> Alterations ........... { ............................. , ....................................................... 383.00 <br /> Permit Renewal. Field Visit ............................................................................................................... 252,00 <br /> Permit Renewal, No Field Visit ................................. ................................................. 120.00 <br /> Au horiza on. F e d V s .................................................................................................................. 252,00 <br /> Authorization. No Field Visit ............................................................................................................ 122.00 <br /> Exlsting System Evaluafio, ............................................................................................................... 252.00 <br /> Annual Evaluation Tempo.r, ary/Hat&hip MoD e Home ............ /88 00 <br /> Annual Evaluation. L&rge Systora ............................................ ]]]][][][.22][]]]]]]][][][]][2[2[22]]]]]i]][][][[2[2[[[[] 128[00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br /> P/imper Troek Inspection. First Vehicle ...................... . ................................... <br /> PumperTra& nspec on,~aaddtona Whc¢ ................................................................... ::::::::!g0=:000o <br /> Septic Reinspecfion Fee ............................................ , ...................................................................................... 25.00 <br /> Septl¢ Inspection tbr which no fee 8 specifically indicated .............................................................................................. <br /> <br />Tank Pumped .... .//~/.~t <br /> <br />Pumping Cer0fication Attached: (Y) (N) <br /> <br /> <br />