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/ ' FOR CI~V USl~ ONLY I MARION COUNTY BUILDING INSPECTION ~ ..... ~-~--~ '~ '~/~,i~ f · ] '"~ ~ ~ ~ ~ COMM~ DEVELOPMENT CENTER ~ ~ , ~. ' ~ ~ ~ /Received B'" gl i .~~~ 285 Ch~ch St. NE - Room 132 : ): [~ ~ . y. t ~ Salem O~gon97301 .2~ ~ : ~ .- ~:~ ~ [Z°n'ng Vahdat'°nL ~ [ T s:oo.m.:30~m ~.o.~ ssms,47q~ -~t~ , _..~,~,, ]Date' ~ -~'~ ] 24hr. lnspecfionLineS~-7904 I~'I;:~,Y.:~ UU.J:q I / ' '¢ / V~ 58a-794S BUILDING INSPECTION SIT~ EV~UATION AND/OR S~PTIC P~IT APPLICATION 1. LOCATION OF INSTALLATION Lot Width ! t ~./. q$' 2. CONTRACTOR INFORMATION IRange ^c s Mailing Address Zone I~eg. Lot ITax Acct. No. [Map I Co er Phone No. 2 ~O~.~.q3 Z 0 Cross Street ~, ~_jl~ r~-- ed Use of Structure ~ No. Employees ~ Existing No. Pm~ No. ~ ~ Bedims B~ ~ Water Supply: Private Well ( ) Spring ( ) Community Well ( ) City (,~ Property Owner Mailing Address Phone No. Auth. Agent/Leasee Mailing Address Phone No. Contractor Business Name & Number~.[ t~"~ ' ~ x..., C' ** Fees include DEQ Sumharge ($30.00) Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, fn'st 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commemial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 Construction Permit or Commercial Major Repair, first 1000 gallons: ~( Standard System ................................................................................................................................. 382.00 Aerobic System .................................................................................................................................. 218.00 Capping Fill System ........................................................................................................................... 593.00 Cesspool ............................................................................................................................................. 382.00 Disposal Trench in Saprolite .............................................................................................................. 382.00 Evapotranspiration-Absorption System ............................................................................................. 218.00 Gray Water Disposal Sump ............................................................................................................... 190.00 Pressure Distribution System ............................................................................................................. 553.00 Redundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 Seepage Pit ......................................................................................................................................... 312.00 Seepage Trench .................................................................................................................................. 382.00 Steep Slope ......................................................................................................................................... 382.00 Tile Dewatering System ..................................................................................................................... 550.00 Construction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee Commercial Plan Review 600 gallons - 1000 gallons ............................................................................................................... 133.00 1000 gallons - 2500 gallons ............................................................................................................... 133.00 Commercial Minor Repair ............................................................................................................................................... 173.00 Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 Residential or Commercial: Alterations .......................................................................................................................................... 378.00 Permit Renewal, Field Visit ............................................................................................................... 227.00 Permit Renewal, No Field Visit ......................................................................................................... 115.00 Authorization, Field Visit .................................................................................................................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 Existing System Evaluation ............................................................................................................... 247.00 Annual Evaluation/Alternative System .............................................................................................. 247.00 Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183.00 Annual Evaluation, Large System ..................................................................................................... 123.00 Pump or Dosing Siphon ....................................................................................................................... 25.00 Pumper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 Pumper Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Reinspection Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr + $100/500 gallons + $25/500 gallons + $25/500 gallons Name of Applicant (Please MC 15-SI Rev 8/95 Receipt: