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· ~FOR CITY USE ONLY , ReceAved By: _ _ Zoniflg Validation: Date: MARION COUNTY BUILDING INSPECTION COMMUNITY D£VELOPMI/NT CENTER 285 Cho~h St. NE - Ronra 132 Salem, Oregon 97301 8:OOam.-4:3Opm Phone ~147 24 bt*. Inspection Line S88-7904 FAX ~88-7948 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION 1. LOCATION OF INSTALLATION 2. CONTRACTOR INFORMATION Pro~y ow~ Aut~ Agent/Le~me 3. FEES [ Mail/hi Addr~s Phone No, ** Fe~s include DBQ ~har~ ($30.00) Site Evaluation, Siagle Family I)walling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ca addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, fa'st 1000 gallons ............................................................................................................. 320.00 Site Evahiatioa, Commemial 1000 - 5000 gallons........~ ................................. ~ ............ ~ ................ ; ........... 320.00 + $90/500/gal Site Evaluation, Rural Area Variance ........................................................................................... : .................................. 320.00 Corzmmfion P~nnit or C~hl Major Rq~f~, fn~ iO06 gallons; Standard System ................................................................................................................................. 382.00 Aerobic System ............................................................................... ~ .................................................. 218.00 Capping Fill System ..................... ~ ..................................................................................................... 593.00 C~pool ........... ~ ........................................................................................ ; ........................................ 382.00 Dispnsal Trench in Seprolite_~...; ....................................................................................................... 382.00 Evepotranspiration-Absorption System ............................................................................................. 218.00 Gray Water Dispo~l Sump .............................................................................................................. AGO.00 Pressure Dl~butio~ System ............................................................................................................. 553.~O Rodundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................. ~ ............... 703.00 ~ ........................................................................................................... 312.00 S~'psge Tronch .................................................................................................................................. 382.0(} S~ Slep~ ............................................................................................................... ~ ......................... 382.00 Tile Dewaterin~ System ..................................................................................................................... 550.00 Construction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee Commercial Plan R~view 600 gallons - 1000 gallons ............................................................................................................... 133.00 1000 galloas - 2500 ~allons ............................................................................................................... 133,00 Commewiai Minor Repair .............................................................................................................................................. 173.00 Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 Single Family Dwelli,E; Major Repair (dralnfield) ........................................................................................................ 210.00 Residential or Comm~ial: Alten~tions ............................................................................................................................. ~ ........... 378.00 Permit Re~wai, Field Visit ..................... : ......................................................................................... 227.00 permit Re~vai, No Field Visit ......................................................................................................... 115;00 Author~zaton, Field Visit .................................................................................................................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 F. xistiag System Evaluahon .............................................................................................................. 247.00 Annual Evahiahce/Alternative System ............................................. ;...~ ................................ ~ ........... 247.00 Annual Evaiua~on Temporal/Hardship Mobile Home ................. : .................................................. 183.00 Annual Evaluation, Large System ..................................................................................................... 123.00 Pump or Dosing Siphon .............................................................. ~ ........................................................ 25.00 Pumper Truck Inspection, Fir~ Ve3~iclo ................................................................ : ........................................................... 67.00 Pumper Tru~k Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Rainepection Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr + $100/500 gallons + $251500 gallons + $25/500 gallons Date: Test Holes P~ady: Tank Puml~d: PUml~g Certificaf~,o~ Attired: (Y) (~)