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F?R CITY USE ONLY <br />~eived By: -- <br />Zoning Validation: <br /> <br />Date: <br /> <br /> SITE EV~I~I~OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION BUILDING ]~I$?ES3q0N <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />Mailing Address <br /> <br />Mailing Addr~s <br /> <br />Phone No., <br />Plane No. <br /> <br />3. FEES <br /> <br />** F~es i~lu~e DEQ Sureha~ (S30.00) <br />Site Evaluation, Single Family Dwelling, fir~ lot ......................................................................................................... $320.00 <br />Site Evaluation, Single Family Dwelling, ~a addl lot ...................................................................................................... 235.00 <br />Site Evaluation, C~ial, f~t 1000 gallo~ ............................................................................................................. 320.00 <br />Site Evaluation, Co--iai 1000 - 504)0 gallons .................................................................................... 320.00 + $9~/500/gal <br />Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 <br />Constxuclion Permit or Common:iai Major Repair, fu-st 1000 gallons: <br /> Standard System ................................................................................................................................. 382.00 <br /> Aerobic System .................................................................................................................................. 218.00 <br /> Capping Fill System ................................................................................................................. ~ ......... 593.00 <br /> Cesspool ............................................................................................................................................. 382.00 <br /> Disposal Trench in Saprolite .............................................................................................................. 382.00 <br /> Evapotranspitation-Absorpfion System ............................................................................................. 218.00 <br /> Gray Water Disposal Sump ............................................................................................................... 190.00 <br /> Pressure Distribution System ............................................................................................................. 553.00 <br /> R~andant System ............................................................................................................................. 382.00 <br /> Sand Filter System ............................................................................................................................. 703.00 <br /> Seepage Pit ......................................................................................................................................... 312.00 <br /> Seepage Trench .................................................................................................................................. 382.00 <br /> Steep Slope ......................................................................................................................................... 382.00 <br /> Tile Dewatedng System ..................................................................................................................... 550.00 <br />Construction Permit or Commercial Major Repair, over 1000 gallons: <br /> Construction Permi~ Fee <br />Commercial Plan Review <br /> ~00 galloos - 1000 gallons ................................................................................................... <br /> 1000 gallons ~ 2500 gallons ............................................................................................................... 133.00 <br />Commercial Minor Relmir ............................................................................................................................................... 173.00 <br />Single Family Dwelling, Minor Rtl~r (tank only) ......................................................................................................... 130.00 <br />Single Family Dwalling, Major Repair (dralnfield) .............................. <br />Residential or Commercial: <br /> Alt~ntions .......................................................................................................................................... 378.00 <br /> Pcmsit Renewal, Field Visit ............................................................................................................... 227.00 <br /> Permit P, en~wal, No Field Visit ......................................................................................................... 115.00 <br /> Authorization, Field Visit .................................................................................................................. 247;00 <br /> Authorization, No Field Visit ............................................................................................................ 117.00 <br /> Existing System Evaluation ............................................................................................................... 247.00 <br /> Annual Evaluation/Alt esnative System .............................................................................................. 247.00 <br /> Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183.00 <br /> Auroral Evaluation, Large System ..................................................................................................... 123.00 <br /> Pump or Dosing Siphon ...................................................................................................................... ~25.00 <br />Pumper Track Inspection, First Vehicle ............................................................................................................................ <br />Pumper Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 <br />Septic Reinspection Fee ..................................................................................................................................................... 25.00 <br />Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br />+ $25/500 gallons <br /> <br />~ q <br /> <br />Test Holes Ready: <br />Tank Pumped: q --lO <br />Pmnping Cerfifimtion A~ch~:~ ~ <br /> <br /> <br />