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MARION COUNTY BUILDING INSPECTION <br /> <br />-.. ?(JR~IT, Y USE ONLY <br />Received .By: _ _ <br /> Zoning Validation: <br /> <br /> Da~c: <br /> <br />285 Church St, NE - Room 132 <br />Salem, Oregon 97301 <br />8:00am-4:30pm Phone 588-5147 <br />24hr. Inspec,on Line 588-7904 ~JUN 1 ~ 1996 <br />FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPL][~l~0~J~'~' <br />1. LOCATION OF INSTALLATION <br /> <br />Subdivision Lot Block No. Employees <br />Section Township P,~mge Zone Map Water Supply: <br /> Private Well () Spring <br />LotWidtb IOt~. LotOcp~ ~_4~.~'7 Acres y,~_. lrveg. Lot Comer CommunityWcll ( ) City <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />Mailing Address Phone No. <br />Mailing Ad&ess Phone No. <br />Mailing Ad&ess Phone No. <br /> <br />3. FEES <br /> <br />** Fees include DEQ Suroharg~ ($30.00) <br />*Site Evaluation, Single Fmnily Dwalling, first lot ......................................................................................................... $320.00 <br />Site Evaluation, Single Family Dwelling, ea eddl lot ...................................................................................................... 235.00 <br />Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 <br />Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gel <br />Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 <br /> Construction Permit or Commercial Major Repair, fitst 1000 gallons: <br /> Standard System ................................................................................................................................. 382.00 <br /> Aerobic System .................................................................................................................................. 218.00 <br /> Capping Fill System ........................................................................................................................... 593.00 <br /> Cesspool ............................................................................................................................................. 382.00 <br /> Disposal T~ench in Sapmlite .............................................................................................................. 382.00 <br /> Evapo~xan spiration-Abso~ption System ............................................................................................. 218.00 <br /> Gray Watc~ Disposal Sump ............................................................................................................... 190.00 <br /> Pr~sgure Distribution System ............................................................................................................. 553.00 <br /> Redtmda~ System ............................................................................................................................. 382.00 <br /> Saad Filter System ............................................................................................................................. 703.00 <br /> Seepage Pit ......................................................................................................................................... 312.00 <br /> Seepage T~cnch .................................................................................................................................. 382.00 <br /> Steep Slope ......................................................................................................................................... 382.00 <br /> Tile Dewatering System ..................................................................................................................... 550.00 <br /> Constmctioa Permit or Comme~--inl Major Repair, ovcc 1000 gallons: <br /> Construction PcrmR Fee <br /> Commercial Pkan Review <br /> 600 gallons - 1000 gallons ............................................................................................................... 133.00 <br /> 1000 gallons - 2500 gallons ............................................................................................................... 133.00 <br /> Conunercial Minor Repair ............................................................................................................................................... 173.00 <br /> Single Fn~ly Dwelling, Minor Repair (tank enly) ......................................................................................................... 130.00 <br /> Single Fn~ly Dwetiing, Major Repair (drainfield) ........................................................................................................ 210.00 <br /> R~sldentinl or Commercial: <br /> Aitecations .......................................................................................................................................... 378.00 <br /> Permit Renewal, Field Visit ............................................................................................................... 227.00 <br /> Permit Renewal, No Field Visit ......................................................................................................... I 15.00 <br /> Authorization, Field Visit .................................................................................................................. 247.00 <br /> Authorization, No Field Visit ............................................................................................................ 117.00 <br /> Existing System Evaluation ............................................................................................................... 247.00 <br /> Annual Evaluation/Alt emative System .............................................................................................. 247,00 <br /> Annual Evaluation Temporal/Hardship Mobile Home .................................................................... 18~,00 <br /> Annual Evaluation, L~rgo System ..................................................................................................... 123.00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br /> Pumper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 <br /> Pumper Truck Inspection, Ea Additional Veh~alc ............................................................................................................. 40.00 <br /> Septic Reinspcction Fee ..................................................................................................................................................... 25.00 <br /> Septic Inspection for which no fee is specifically in<fiesta1 .............................................................................................. 40,00/hr <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br />+ $25/5~0 gallons <br /> <br />N~m~ of Applicant (Please Pr~'~N ~"~ , .~v~ <br /> <br />=ate: <br /> <br />Receipt:_ <br /> <br />Test Holes Ready: <br /> <br />Tank Pumped: <br /> <br />Pumping Certification Attached: (Y) <br /> <br /> <br />