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I FO~i CITY USE ONLY MARION COUNTY BUILDING INSPECTION · COMMUNITY DEVELOPMENT CENTER /Re'c.eiv~d By: ..~(.. 285 ChurchSt. NE - Room 132 ~Zoning Validation: ~ Salem, Oregon97301 ~l~ 8:00am~:3Opm Phone 58~5147 /mt : ~ 6 24 hr. InspectionF~ 588-7948Line 588-7904 SITE EV~UATION AND/OR SEPTIC PE~IT APPLICATI 1. LOCATION OF INSTALLATION Job Address /~t~ e/l"~VO r'~ Section O/ IT°wnship LotWid 75-- / 2. CONTRACTOR INFORMATION Range g~ Zone R5 [Map /O Acres Irreg. Lot Comer Auth. Agent/Leasee Cn ~ss Street Us a of Structure No. Employees ExNting No. Proposed No. Be~lrooms Bedrooms Water Supply: Private Well ( ) Spring Community Well ( ) City Mailing Address Mailing Address Contractor Business Name & Number Mailing Address 3. FEES ** 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, fu'st 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-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 q07~'~l ~~ ~,z ' ' ~ ~ ' I Phone No. Phone No. + $100/500 gallons + $25/500 gallons + $25/500 gallons Name of Applicant (Please Print): ~L'~U~'~ h /~ t9 5'"'~'/a/~tt~ Signature of Applicant: ./~_~**_~. / (/'~~t~ Date: MC 15-S! Rev 8/95 Test Holes Ready: Tank Pumped: Date Date Pumping Certification Attached: (Y) (lq)