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FOR CITY USE ONLY <br />ec~ivedBy: __ <br />nin~g. Valid~tion: <br />ate: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> $:00am-4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />L LOCATION OF INSTALL3 ION <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />3. FEES <br /> <br />Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal <br /> <br /> Gray Water Disposal Sump ............................................................................................................... 190.00 <br /> <br /> Redundant System ............................................................................................................................. 382.00 <br /> Sand Filter System ............................................................................................................................. 703.00 <br /> Seepage Pit ......................................................................................................................................... 312.00 <br /> <br /> Steep Slope ......................................................................................................................................... 382.00 <br /> <br /> 1000 gallons - 2500 gallons ............................................................................................................... 133.00 <br /> <br />Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 <br />Single Family Dwelling, Major Repair (dralnfield) ........................................................................................................ 210.00 <br />Residential or Commercial: <br /> i..--..-Alterations .......................................................................................................................................... 378.00 <br /> <br /> ........................................................................................................... 247.00 <br /> <br /> ( Ang~, Evaiuatton'?em~5o~ M6bile Home...~l ....... 18300 <br /> ~h~ual gqhrnAii6~i:La~g'~yS~"~stg~"~.'...,:.::,,.,,,.:;:.CL,........~ .......]][].]]]]]]]]]]]]]]]]]]2]]]]]]]]..]] .................... 123.00 <br /> Pamp or Dosing Siphon ....................................................................................................................... 25.00 <br /> <br />Septic Reinspection Fee ..................................................................................................................................................... 25.00 <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br />+ $25/500 gallons <br /> <br />Receipt:. <br /> <br />Date: <br /> <br />Test Holes Ready: <br /> <br />Tank um d: <br /> <br />Pumping Certification Attached: (Y) (N) <br /> <br /> <br />