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'] FOR CITY USE ONLY MARION COUNTY BUILDING INS~E~C~ ff ~ [r~n I'~,~ i ~Bv' lV¢l ~ll 285ChmhSt~ - Room 132 I~a'~: ~ 'W ' F~$S~7948 6UILDIN~q cuuN/y ~w -- ~ ' SITE EV~UATION AND/OR SEPTIC PE~IT 1. LOCATION OF ~ST~LATION Job Address t~O~ ~ .~ ~a~.~ ~J ~, Tax Acer. No.q'~/ q 0 "[ 7~) Cm~ St~t O~ ~, Widh t~, Lot D~ Ac.S ~. Lot y ~ Comer g~ ~m~ Well 2. CONTRACTOR INFORMATION 3. FEES ** F,es include DEQ gumharge ($30.00) $ Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, S~_gle Family Dwelling, e,a addl lot ...................................................................................................... Site Evaluation, Commercial, first 101)0 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal i~ Sd 00/5~0 gallons Site Evaluation, Rural Area Vsrianc¢ .............................................................................................................................. 32~010~tI I /, Construction Permit or Commercial Major Repair, first 1000 gallons: ~'~ ~-~J~[ Standard System ................................................................................................................................. 38~00 v t~,~.~. ~'~- 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 Smp ............................................................................................................... 190.00 pressure Distribution System ............................................................................................................. 553 Redundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 Seepage Pit ......................................................................................................................................... 312.00 Seepage Trench .................................................................................................................................. 382.00 Steep Slop~ ......................................................................................................................................... 382.00 Tile Dewatering System ..................................................................................................................... 550.00 Construction Permit or Commemial Major Repair, over 1000 gallons: Construction permit Fee + $25/500 gallons Commercial Plan Review 1500 gallons - 1000 gallons ............................................................................................................... 133.00 1000 gallon[ - 2500 gallons ............................................................................................................... 133.00 4- $25/500 gallon~ COJnn3,rcial Minor Repair ............................................................................................................................................... 173.00 Sihgl~'Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 Single Family Dwelling, Major Repair (dminfield) ........................................................................................................ 210.00 r~ Residenilal or Commercial: Alterations .......................................................................................................................................... 378.00 permit Renewal, Field Visit ............................................................................................................... 227.00 permit R~newal, No Field Visit ..................................................................................................... L. 115 Authorizmion, 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 Pttmpar Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Ralnspaction Fee ........~ ............................................................................................................................................ 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00Au- Name ofApplicant (Please Print): ,~)~ ~ MC IS-S1 RevS/95 Receipt: TestHolesReady: /~j?; ~ Tank Pumped: Date Pumping Certification Attached: (Y) ('lq)