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FOR,CITY USE ONLY I~M~I~)~UNTY BUILDING INSPECTION <br /> · , i.VJl~ (: C~~OPMEmCEN~R Ill]~ <br /> <br /> ~I~ ~~R SEPTIC PE~IT APPLICAT~O/NG <br /> <br />2. CONTRACTOR INFORMATION <br />Property Owner Mailbag Address Phone No. <br />Auth. Ag~n~l.~as~ Mailing Add.ss Phon~ No. <br />Contractor Business Name & Number M~ng Address ~ No. <br /> <br />3. FEES <br /> <br />** Fees include DEQ <br />Site Evaluation, Single Family DweRing, first lot ......................................................................................................... $325.00 <br />Site Evaluation, Single Fan~y DwcL~ng, ca addl lot ...................................................................................................... 240.00 <br />Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 325.00 <br />Site Evaluation, Commeicial 1000 - 5000 gallons .......................................................................................................... 325.00 <br />Site Evaluation, Rural Area Variance .............................................................................................................................. 325.~0 <br />Constluction Permit or Commercial Major Repair, first 1000 gallons: <br /> Standard System ................................................................................................................................. 387.00 <br /> Aerobic System .................................................................................................................................. <br /> Capping Fill System ........................................................................................................................... <br /> Cesspool ............................................................................................................................................. 387.00 <br /> Disposal Trench in Saprolite .............................................................................................................. <br /> EvapoffanslYLration-Absorption Sysmm .................................................................... 223.00 <br /> Gray Water Disposal Sump ............................................................................................................... <br /> Holding Tank (Comme~-~al only) ...................................................................................................... 387.00 <br /> Fressum Dis~bution System ............................................................................................................. <br /> <br /> Seepage Pit ......................................................................................................................................... 317.00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br /> <br />+ $100/500 g~llons <br /> <br />+ $25/500 gallons <br />+ $25/500 gallons <br /> <br />dgnatura of Applicant: <br /> <br />Date: <br /> <br />Receipt: ~... _ <br /> Pumping Certification Attached: (Y~ <br /> <br />(ND <br /> <br /> <br />