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FOR.CITY USE ONLY ,R'~ceived By: Zoning Validation: bate: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St. NE - Room 132 Salem, O~gon 97301 8:0~un-4:30pm Phone S88-$147 24 hr. Inspection Line S88-7904 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION 1. LOCATION OF INSTALLATION ,*^,~ ~(o~'-~ ,~tme~. ~ 5,~ [ T,~^~,~.. qoq/o o9/ ,,4a, m~aY]l~ ~9~ ctqaj2..~' 2. CONTRACTOR INFORMATION I Propet~ Owner Mailing Address ~ No. Auth. Agem/Leasee Mailing Addre~ Phons No. Contr~-torB~iee~sNnme&Number --q ~~'~"-- MailingAddr~s PhoneNo. .vzzs ** Fe~ includ~ DEQ Suwharge ($30.00) Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ~a addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 Site EvalUation, Comnm~ial 1000 - $000 gallons .................................................................................... 320.00+ $90/500/gal + $100/500 gallom Site EvalUation, Rural Area Variance .............................................................................................................................. 320.00 Consmaction Permit or Commercial Major Repair, fi~t 1000 gallons: Standard Sysmm .............................................................................................................................. Aerobic System .................................................................................................................................. 2 ! g.00 Capping Fill System ................. .. ......................................................................................................... 593.00 ~1 ............................................................................................................................................. 382:00 Disposal Trench in Saprolite .............................................................................................................. 382.00 Evapotranspiration-Absorption System ............................................................................................. 21 $.00 Gray Water Disl~ Sump ............................................................................................................... 190.00 Prcssurc Distribution System ............................................................................................................. 553.00 Redundant System ............................................................................................................................. 382.00 · Sand Filter System ............................................................................................................................. 703.00 S~mpage Pit ......................................................................................................................................... 312.00 Seepage Trench ......................................~ ........................................................................................... 382.00 Steep Slope ......................................................................................................................................... 382.00 Tile Dewatering System ........................................................................... ~ ......................................... 550.00 Co~slruction Permit or Commercial Major Repair, over 1000 gallons: Construction Pemait Fee + $25/500 gallons Commercial Plan Rt~view 600 gallons - 1000 gallons ............................................................................................................... 133.00 1000 gallons - 2500 gallons ............................................................................................................... 133.00 + $25/500 gallons Commercial Minor Repair ............................................................................................................................................... 173.00 Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 Single Family Dwelling, Major Rep~fir (drainfield) ........................................................................................................ 210.00 Residential or Commercial: Altea'ations .......................................................................................................................................... 378.00 Permit Renewal, Field Visit ...................................................................... ; ..................................... 227.00 ~,~t ~-~w~, So Fi, la visit ....................................................... (....l.t.........~.t..~ ......... :... !!5.00 Authorization, Field Visit ................................................................. - --- -- --~,d..~....~,~..-...~i,f,). .................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 Existing System EvalUation ............................................................................................................... 247.00 Annual Evaluation/Alternative Syatem .............................................................................................. 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 Name of Applicant (Please Print): Signaturc ot Applicant: ~-t~_-~~ ~,~ 1 ~;-RI Rev 8/95 ~'~ Date: Receipt: Total: Test Holes Ready: D~ Tank Puml:~d: Pumping Certification Attached: (Y) iN)