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I FOR CITY. USE ONLY ] MARION COUNTY BUILDING INSPECTION ~5~}~(~j~j~,~ ~ ~-~ <br />I · q.) ~9 ~ I COM~YDEVELOPME~CE~ER 1~{ I~~ ? ~ I ~ I I <br />IR~vedBy: ~~ 285 ~hSt.~ - g~m 132 I]~l~ NI Il I <br />I : . . ~ ~ S~em, O~gon97301 Jl~ ..... ~ .~ <br /> <br />I~ --. r - s ~ O ~ I 24 hr. Inspection Line ~-7904 ~ ~ ~ // <br />SITE EVALUATION AND/OR SEPTIC PE~iT APPLiCATI~iLDINa INSPECTION <br />1. LOCATION OF ~ST~LATION ~ ~ ~{ ~ ~ S ~ ~& ~ <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />3. FEES <br /> <br /> Site Eval~tio~ S~gle F~ily Dwell~g, fi~t lot ......................................................................................................... $320.~ <br /> Site Eval~tio~ S~e F~ily Dwellin~ ea a~l lot ...................................................................................................... 235.00 <br /> Site Eval~ti~ ~mm~ial, ~ 10~ ~lons ............................................................................................................. 320.00 <br /> Site Eval~tio~ ~ial 1000 - 50~ ~llons .................................................................................... 320.~ + $90/500/gal <br /> Site Eval~ti~ R~al ~ V~ .............................................................................................................................. 320.00 <br /> Co~ction P~it or Co~e~i~ Major R~air, fi~t 10~ ~11o~: <br /> S~d System ................................................................................................................................. 382.00 <br /> A~bic System .................................................................................................................................. 218.00 <br /> Capping Fill S~t~ ........................................................................................................................... 593.00 <br /> Cesspool ............................................................................................................................................. 382.00 <br /> ~ T~ch in Sapmlite .............................................................................................................. 382.00 <br /> Evapo~spiration-Abso~t on System ......................................................................................... 218.00 <br /> <br />Name of Applicant (Please Print,: % 'X'""' ~ C~"~ .~-'~ <br />Signatare of Applieant~ <br />MC 15-S1 RevS/95 <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br /> <br />+ $25/500 gallons <br /> <br />Receipt: Total: <br /> <br />Date: <br /> <br />Test Holes Ready: <br />Tank Pumped: <br /> <br />Pumping Certification Attached: (Y) (N) <br /> <br /> <br />