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FoR ~FFICE USE ONLY <br />R~ived By: ~ <br />Zoning Validation: <br /> <br />1. Loation of Installation <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8.'00 am - 4:30 pm Phone 58g-5147 <br /> Code-A~l~me 588-7904 <br /> FAX 588-7948 <br /> <br />#kY28 1992 ' <br /> <br />SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION ~,i i~SDF. CTIO[~ <br /> <br />2. Contractor Infornmtion <br /> <br />Property Owner Mailing Address: Phone No. <br />Auth. Age~ee Mailing Address: Phone No. <br />Con~_actot BUSiness Name & Number Mailing Address: = Phone NO, <br />DEQ Licensed Contractor & No. Mailing Address: Phone No. <br /> <br />3. Fees <br /> <br />Site Evaluation, r~,st looOSal. DSF~ $ 200~oo $20.00 <br />Site Evaluation, ea. addl. 500 gal. DSF 60.00 20.00/n <br />Consuu~on & ~epair <br />.Standard System less than. ~000 gal. DSF 200.00 10,00 <br />Stand~d 5~tem n~re than i000 g~l. DSF: <br />$200.00 + $15/each addl. 500 gal. DSF 10.00 <br />Capping Fill 330.00 10.OO <br />Di~Tren¢~ inS.~o~ite 2OO. OO10.00 <br /> S. 9S.OO' 10.00 <br />Ho~dlngTank , . 2OO~00! i0.OO <br />Pr~e Dis~ibufi6n 2~0.0~ 10.00 <br />Redundant system . . 2OO,0~ 'i0.00 <br />Sand Filter 355.0(3 10.OO <br />Seepage Trench 200.00 10,00 <br />Steep Slope 200.00 10.OO <br />Til~ ~wate~in~ system 2a0.oo 16.oo <br />Plan Review <br />600 gal. DSE..IOOl gal. DSF 80.00 .OO <br />(except SAND FILTERS) <br />For each additional 500 gal. DSF 20.00 .OO <br />Alterations 2OO. OO 10.00 <br />Repair, Minor' 60.00 10.00 <br />Con .sa'Uction Permit ReneWal (Field Visit~) 120~00 10:OO <br />Construction Permit Renewal (No Field Visits) 70.OO 10.OO <br />Existing Sys~m Evaluation Reix~rt 120.00 10.OO <br />Authorization Notice (Field Visit) 120.OO 10,OO <br />Authorization Notice (No Field Visit) 70.00 10.OO <br />Annual Evaluation 0fAlternative System 120.00 10.00 <br />Annual Evaluation of Large System 75.00 10.OO <br />Pun~er Track Inspection, First lmck 50.00 .OO <br />Pmr~per Truck lnpsection, ea. addl. uuck 35.0~ .OO <br />Other <br /> <br />(Mark ff Applicable to this Application) <br />( ) Test Holes are Dug <br />( ) I will call when Test Holes Dug <br /> <br />( ) I am performing work on a properly I own or occupy <br />( ) I am a registered builder or ( ) ~he authorized representative <br /> of a registered builder. <br />( ) The work will he performed by a DEQ Licensed Installer <br />( ) Other ' <br />( ) I agree to install according to the submitted plans and <br /> specifications, the laws of the State of Oregon and the <br /> ordinances of Marion County. <br /> <br /> Residential Single Family <br /> Site Evaluation, fa-st lot $ 2OO. OO $20.OO $ <br />Site Evaluation, ea. addl. lot 165.00 20.OO <br />Conslruction ,p~t <br />Standard System 200.00 10.OO! <br />Capping Fill' ]~0~OO 10.OO <br />Disposal Tre.ch in Sap~olite 2OO.0~ 10.OO <br />Gray Water Disposal Sump 95.00 10.OO <br />Holding Tank 200.00 . IO.OO <br />Pressure Di~ibutio~t 280,00 10.OO <br />Redundant 200.00 10'.OO <br />Sand Filter 355.O0 IO~OO <br />S~e. Trench 2OO, OO IO. OO <br />Steep Slope 200.00 10.OO <br />Tile Dewatering 280.OO IO.OO <br />.Altera6on 2OO.OO fO.OO <br /> <br />Repair, Minor (amk) ' .': OO. OO 10:OO <br />Consa'uction Permit Renewal (Field Visit) '~ 120.00 10.00 <br />Consuuction Permit Renewal (No Field Visit) . 70.00 10.OO <br />Reinspection Fee ~. 25.00 .OO <br />Authorization Notice (Field Visit) 120.00 10.00 <br />Authorization No6ce (No field visit) 70.00 10.OO <br />Exi~6ng System Evaluation 120,00 IO.OO <br />Annual Evaluation/Altemativ© System 120.00 .OO <br />A~nual Evaluation/Temp. or Hardship MH 75.00 .OO <br />Rural Area Variance Site Evaluation 200.00 20.00 <br /> <br />NAME OFAPPI~ICANT le tint): <br />SI(~NATURE O~rAPPI~ICANT: O DATE: <br /> <br />MC 15-74 REV 1/92 <br /> <br /> <br />