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<br />Received By:-/Y ~
<br />Zoning Validation
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />
<br /> SITE EV~UA~ON ~/OR SEP~C PE~IT ~PLICA~ON
<br />1. Location of Installation
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<br />Su~0ix~,~/°n --~ O~ ' i ~t~, IJ Block
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<br />~tWidth lL~ I ~tDePth I¢l ]Ac.s 1i~2~t [~0mer
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<br />Commercial (DSF - Daily Sewage Flow) ;
<br />Site Evaluation, first 1000 ,~1. DSF 245~00 ...... 20.00
<br />Site Evaiuatio~l, es. ~dl. 500 Sat.
<br />Constmctlon ~ Repair Pemit~ ...........
<br />StandaM $~stem less than 1000 ~1, DSF 245,00 ; 10~00
<br />Standard System mo~ than 1000 ~ai.
<br />Disposal Tmn~h~s in 8apmlit~ 245.00 10;00
<br />~olding Tank ......... 24~.00 10~00
<br />.......~(Fss,um ~istfibution ~S0.00 10~00
<br />RadunO~nt~sto~ 245.00 10~00
<br />~ilter .,~45,00 10;99
<br />Seepage ~neh ....... 245,00 ,.,, 1,9.00
<br />Til~ Dewatefing SVs~m .... 350,00 ,,,:, 10;00
<br />(FOr ca~h addltionai 50q, ~al. DSF
<br />ARemtlong 245,00 ..... '16:00
<br />,~g,~[t Minor 75.00 .,L 10}00
<br />~nstmctlon Po~it R~newai (Field Visit) 1,50,00 I0;00
<br />~istin$ System Evaluat~,~ ~poR 150.00
<br />Authorization Noti¢* ~o Field Via}t) 85.00 10;00
<br />Annual Evaiuatlon of AItomatiye System 150.09 : 10:00
<br />Annual Evaluation of La~e System .... 90.00 : I0.00
<br />..... ~mper Tm~k In~ection, pi~t tmek 50.00 .00
<br />~mperTmgklnspeq,[{on, oa ~d track 35.00 ,~0
<br />
<br />(Mark if Applicable to this Application) ) Test Roles are Dug
<br /> ) I will call when Test Holes Dug
<br />
<br /> Residential Single Family $
<br /> Site Evaluatio~..fitst lot 245.00 ~'0.00
<br />.... $itg. Evaiuat on, ea. add ct 20S.00 20.00
<br /> Construction pc~!f,
<br /> Standard Syst~ra ...... 245 .'~'$ 10-00
<br /> Capping Fill ........ 415,00 . ,10t00
<br /> ,Redundant ..... 245.00 10.00
<br /> SeePage T~n~h .,, 24~.00 I0.00 ....
<br /> Tilt Dcwa.tolJn8 .... ~S0,00 10~00
<br /> Alt~ratlon 245.00 10.00 glo; ~',~
<br /> Repai,~ Major (dtainfi¢ldi .... 115.00 10.00,,
<br /> Repair, 1vfinor (tank~ ,, 75.00 10.00
<br /> Construction Permit Renewal (Fie d y s t) 1 $0.00 10.00
<br /> Authofiggion Notivc (Field Vi$i~) 15o,o0 10,00 ......
<br /> Authori~p~ion Not ce (No F e d V · ~,, 85.00 l.p.00 t
<br /> Annual Evaluatio~Ai~el~atiw S~'tem 150.00 .00
<br />
<br /> Total
<br />
<br /> ' P~caipt No.
<br />I agree to install according to the submitted plans and specifications, t~¢ laws
<br />of thc State of Oregon and thc ordinances of Marion County,
<br />
<br />'T~ work will be performed by a DEQ Li¢¢nsgd Installer
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<br />SIGNATURE OF DATE:
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<br />~-SI REV 2/93
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