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FQR. CITY USE ONLY Received By: __ IZoning Validation: IDate: MARION COUNTY BUILDING INSPECTI COMMUNITY DEVELOPMENT CENTER 285 Chureh St NE - Room 132 Salem, Oregon 97301 S:00am-4:30pm Phone 24 hr. Inspection Line ,8~-7904 INSPEU SITE EYALUATION AND/OR SEPTIC PERMIT APP~ICA'I]I~tv~'-~ L LOCATION OF INSTAI,I~TION 2. CONTRACTOR INFORMATION Property Owner Auth. Agcat/Leas~ Mailing Address Phone No. Mailing Addr~s 3. FEES ** Fees inelud~ DEQ Surcharge ($30.00) Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addi lot ...................................................................................................... 235.00 Site Evaluation, Commercial, ftrst 1000 gallons ........................................................................... : ................................. 320.00 $it~ Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 Construction Permit or Conunercial Major Repair, first 1000 gallons: Standard System ................................................................................................................................. 382.00 Aerobic System~ ................................................ ~ ................................................................................ 218.00 Capping F~II System ......................... .............. ~ ................................................................................... 593.00 Cesspool ............................................................................................................................................. 382.00 Disposal Trench in Saprolite .............................................................................................................. 382.00 Evapotranspiration-Abso~ption 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 Dewatefing System ..................................................................................................................... 550.00 Constxuction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee Commemial 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: Alteration~ .......................................................................................................................................... 378.00 permit Renewal, Field Visit ................................ ; .............................................................................. 227.00 Pexmit Renewal, No Field Visit ......................................................................................................... 115.00 Authorization, Field Visit .................................................................................................................. 247.00 Authorization, No Fiald Visit .................................................... ; ....................................................... 117.00 Existing System Evaluation ............................................................................................................... 247.00 Annual Evaluation/Alternative System .............................................................................................. 247.00 Annual Evaluation Tomporary/Hard~hip Mobile Home .................................................................... 183.00 , Annual Evaluation, Large Syst~n ..................................................................................................... 123.00 Pump or Dosing Siphon .......................................................................................................... : ............ 25.00 Pumper Track 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 Phone No. + $100/500 gallons Q- qto - + $25/500 gallons + $25/500 gallons Name of Applicant (Please Print): Signatu~ o f Applieam: MC 15-SI RevSD5 Test Holes Ready: /6~O SO Tank Pumpedi Pumping Ceffificadon Attached: (Y) (N)