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~ceivedBy: tx~~ 285 Church St. NE - R~m132 L . . ,,. Q~ ~%~x~ Salem, O~gon97301 IZoning Vali~fi~:. ~, ~' 8:~m4:~m~hone~5147 ~ JUN 1 1 lS97 ~ ~ ~ ~ hr In--on Line [Date: ~ ~ ~W [ ' F~S"-7948 ~PLiCA~ION SITE EVALUATION AND/OR SE~IC PE~IT ~'¢rOlUa INSPECTION ]. LOCA ON OF 2. CONTRACTOR INFORMATION Auth. Agenffl~as~ C°n~ract°r Business Name & Number ~O~ ~ Mailing Address ~~hone~p No. MailiagAddress ['700i{ honeNo. {~l 3. FEES ** Fees include DEQ Sumharg~ ($30.00) Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 Construction Permit or Cormmercial Major Repair, first 1000 gallons: Standard System ................................................................................................................................. 382.00 Aerobic System .................................................................................................................................. 218.00 Capping Fill System ........................................................................................................................... 593.00 Cesspool ............................................................................................................................................. 382.00 Disposal Trench in Saprolite .............................................................................................................. 382.00 Evapot ranspiration -Absorption System ............................................................................................. 218.00 Gray Water Disposal Sump ............................................................................................................... 190.00 Pressure Distribution System ............................................................................................................. 550.00 Redundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 Seepage Pit ......................................................................................................................................... 312.00 Seepage Trench .................................................................................................................................. 382.00 Steep Slope ......................................................................................................................................... 382.00 Tile Dewatering System ..................................................................................................................... 550.00 Construction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee Commercial 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) ......................................................................................................... I30.00 Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 Residential or ~ Permit Renewal, No Field Visit ......................................................................................................... 115 Authorization, Field Visit .................................................................................................................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 E~sting 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 Pumper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 Pumper Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Rethspection Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.O0/hr + $1001500 gallons + $25/500 gallons + $251500 gallons Name of Applicant (Please Print): Signalure of Applicant: MC 15-SI Rev 8/96 Receipt:. Test Holes Ready: ~' ~'~' ~::~7 Date Tank ~m~: ~mping Ce~ifica~on Attache: (Y) (N)