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ReCeived By: ~_ Zoning Validation: IDate: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER O q 1996 285 Church St. NE- Room 132 ~'-~ ~ ~ ~ Salem, Oregon 97301 8:00am-4:3Opm Phone 588-5147 24 hr. Inspection Line 588-7904 FAX 588-7948 · - SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION ......... .. 1. LOCATION OF INSTALLATION Tax Acct. No. Subdivision Lot Block Section / ~ { Township d 5 Range LotWidth /~'-~{ LotDepth 3t~,.~~ Acres Zone / ]Map Irreg. Lot ~ I Comer 2. CONTRACTOR INFORMATION Cross Street UseofStructure~t~ _~'~ (~ ~ No. Employees Existing No. Proposed No. Bedrooms B~trootm Water Supply: Private Well ( ) Spring Community Well ( ) City 3. FEES ** Fe~s include DEQ Surcharge ($30.00) Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 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-Absorpfion 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 f1000 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~Alteruative 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 Reinspectiun Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr + $100/500 gallons + $25/500 gallons + $25/500 gallons 2.0o Name ofApplieant (Please Print): ~e~\~~3 .~ ~_________.~r~ Signature of Applicant: }( --~ ~-~-'~ ' MC 15-SI RevS/95 Receipt:. Total:~ Test Holes Ready: Date Tank Pumped: Date Pumping Certification Attached: (Y) (N)