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MARION COUNTY BUILDING INSPECTION
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<br /> Salem, OR 97301
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<br /> 8.'00 am - 4;~0 IJ~ Phol~e. 588-~147
<br /> C~ ~g-7~
<br /> F~ ~gs-~
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<br /> sITE EVALUATION AND/OR $]gFriC PERMiT APPLiCATiON
<br />1. Loc.~tion of Inst~ll~lion . , ........................ e:]~ ....
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<br /> ~,-~ O ~, ~~ , si~ ~f .... v~as~: ~ ~
<br /> ; ' ~ I~ I~l~k I N~ ~lo~:
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<br />2. Contractor lnfo~mat~on ~
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<br /> Commercial (DSC-Daily Stnvage Flow) R. csidonfial Sin$lc Family
<br /> Si~gvai~:afion, fa'st 1000 ga!, l~Sg $ 2.00.00520.00 $ .~it~Evaluation~flr~l~ ........... $ 200.00 $Z6.1~)
<br /> Site ~val~oa, ea, addl. $(X) alA:D-$F ~0.0~ 20.OOP/f ~ila Rvaluatiml, ca_ addl. lei 165J~0 20,00
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<br /> ~uo~dard Sya~em less r. hag 1000 ~aI, DSF 200.00 '1'0.00 $lall4~d System 20(~.00
<br /> Slandard System more than 1000 gal. I~F; Capping ~11 33~L(X) IO.00
<br /> ',~2o0,00 ,....~}5/~;,a~ ;~a~. ~o6 s~L r)sF .......... moo Di~ T~ca in Sa~-oU.~ ......... zoaeo. ~6;00
<br /> Capping Fill .... ~'i[.'00 '10.00 , ,Gray Wmar Disposal Sump 95.00 lO:iX)
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<br /> Disposal Tmncho~ ~ta ...... 200.00 10.00 Hold,!?8, Ta~k 200,00
<br /> 95.00 I0.{XI Ptcs. mr~ Dis0:ibul}on' - 28O.00 10.00
<br /> Gra[, Wa~r Waal~ Dl~0o~al $ u..m p ..............
<br /> l-toldlngTank 200.00 t0.001 P~dundant 200.IX) 10.00
<br />Prorate Diatribkttioa .............. 280.00 10.0~ ! $aiad l~ilm' 355.00',
<br />: ,,g.?dundant Systen~ ..... 200.00 10.00 i ~eepago TroSch .... ~00.(K 10.00
<br />2ee~age Trench ¢XX),00 10.00 T]I~ Dowamigg '~0',~ 10.00
<br />' Sto~pSIop~ 200.(X lO.OO Alt*tgi/on 200,0~ I0.00
<br />Tilc~WaI~ringSyat~m 280.IX 10,00 Rcpalt, Majtw(draltffiold) 95~ I-~--~-.~--
<br />Plan Review Rcpain M!~? (kqgk) 60, fXI 10,00
<br />, , tcxcept SAND FILTEILg, t,,' Coaalnlqalo. Permil ]~newa] (No Fi~Id Visit) 70.00
<br /> Pot eafh additional ,t~,,,, ~ al. DSF :~,0~ .0~ Relnspectioa ~ 25(00
<br /> ^Iterations ...... gO0.O~ 10.130 At!~Otizatlon lqo~ice (Field Via'it) ~ 12{~,'00 10.~J .......
<br /> ~pa,ir~,Minca ................. 60.0¢ 1o.oo Autilodt;alion No6c~ (No fiald vlait) ?0. tX)
<br /> Co,t~trucdoa...P?mit R*aawal (giaid ViSta) 120.0~ 10.%00 E:¢is~ing System Emlultt~OI1 I2~01'~
<br /> Con~tm*-~ua P~r~git Renewal fNq,,~[oJ,.d ¥1sJtq) 70.00 .,~ q.O0 An nual Evaluation/Ahet n ati'~ 8 y ~aem ........... T2(1 C&) .00
<br /> Bxt~lag ,~y,~t¢,m,Evaluation ~a=Imet 1~0~0 I0.00 Annual Eyalm0tiop~'l]~mp, er ~atdahip MH 75.00 .00
<br /> ,A!!~h~[i3a~i0nNo6oa(FicldVislt~,' 120,00 10,00 I~O.'~ guralArcaVarlancogi~Evaluatlon 200.00 20.00
<br /> Au0aorizatioa Notice (No Pi01d Visit) 70.00 I0.00
<br />~!!m,al ~v,qu~ioa Pr 6!~nati'w System ............... 120.01 10,00II Total $ ]d.~
<br /> A~nua~,Bvaluatie'aofLa~gggystcm 75,00 10.00 '-- ~A'4-o~ ~---.-~-
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<br />(Mark ff ApplicahI~ to Ibis Application)
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<br />%at ~lolea ara Dug
<br /> will call when Te,~t llolt~ Dug
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<br />) [ am a rcgiste, md builder Or ( ) thc authori?z:d t~13r¢,~ntative
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<br /> work will b~ pedorn~:al hy a DgQ IJcenaed lmaller
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