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· COMMUNITY DEVELOPMENT CENTER II~eceive~l By:' ~ (_ 285 Church St. NE - Room 132 [Zonin~ Validation; ~ Salem, Oregon97301 F~ 588-7948 SITE EVtLgtTIO~ i~B/OR SI~TIC ~glT 1. LOCATION OF INSTALLATION Job Ad'ss IL~ ~.~ ~ Cross S~et i Use of Stmc~ Subdivision ~.~.~ Lot~ mock J I No. Employes ' - Existing No. B~ms Section ~ To.ship ~ ~ ~nge~ [ Zone ~ ~ Map~ ~ Water Supply: ~ ~va~ Well 2. Property Owner Mailing Address Phone No. Auth. Agent/Leasee Mailing Address Phone No. Contractor Business Name & Number Mailing Address Phone No. 3. FEES $ Name of Applicant (Please Print): Signature of Applicant: MC 15-SI Rev8/95 ** Fees 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 + $100/500 gallons 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 + $25/500 gallons Commercial Plan Review 600 gallons - 1000 gallons ............................................................................................................... 133.00 1000 gallons - 2500 gallons ............................................................................................................... 133.00 + $25/500 gallons ' ' '. .............................................................................................................................................. 173.00 Single Family Dwelling, Minor Repair (tank onl ............. y) ............................................................................................ 13o.oo 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 Track Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Reinspeetion Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr Reeeipt'~q 1~/Y G Total: Test Holes Ready: ~'~~te: ~ ~.s /79~ Tank Pumped: D;a~ Pumping Certification Attached: (Y) (N)