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FOR CITY USE ONLY <br />R~ceivcd By: __ <br /> <br />Zoning Validation: <br /> <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am4:30pm Phone 588-5147 <br /> Z4 hr. Inspection Line 373..4427 <br /> FAX 588-7948 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />1. LOCATION OF INSTALLATION <br /> <br />CONTRACTOR INFORMATION <br /> <br />3. FEES <br /> <br /> Capping Fill System .................................. <br /> Cesspool. <br /> Disposal Trench in Saprolite ............................... <br /> Evapommspimtlon-Absorption System ........................... <br /> Gray Water Disposal Sump <br /> Pressure Distribution System ................................ <br /> Redundant System ............................. <br /> Sand Filter System ......................................... <br /> Seepage Pit ............. <br /> Seepage Trench ..................................... <br /> Steep Slope .................... <br /> Tile Dewatering System ............... <br />Construction Pennlt or Commercial Major Repair, over 1000 gallons: <br /> <br />......... 593.00 <br />.382.00 <br />..................... 382.00 <br />..................... 218.00 <br />........... 190.00 <br />.... 550.00 <br />............................ 382.00 <br />.... 703.00 <br /> <br />...................... 382.00 <br />........................ 382.00 <br /> ....... 550.00 <br /> <br />Constraction Permit Fee <br /> <br />+ $251500 gallons <br /> <br />Commercial Plan Review <br /> 600 gallons - 1000 gallons ............................................................................................................... 133.00 ' <br /> 1000 gallons - 2500 gallons ............................................................................................................... I33.00 + $251500 gallons <br />Commercial Minor Repair ............................................................................................................................................... 173.00 <br />Single Family Dwelling, MinoJLRe4aai~tank only) ......................................................................................................... 130.00 <br />Single Fanfily Dwelling,L~ ~ ~lJiraln field) ........................................................................................................ 210.00 <br />Residential or Commercial: <br /> Alterations .......................................................................................................................................... 378.00 <br /> Permit Renewal, Field Visit ............................................................................................................... 227.00 <br /> Permit Renewal, No Field Visit ......................................................................................................... 115.00 <br /> Authorization, Field Visit .................................................................................................................. 247.00 <br /> Authorization, No Field Visit ............................................................................................................ 117.00 <br /> Existing System EvaluaOon ............................................................................................................... 247.00 <br /> Annual Evaluation/Alternative System .............................................................................................. 247.00 <br /> Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183,00 <br /> Annua/Evaluation, Large System .............................................................. 123.00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br />Pumper Truck Inspection. Fimt Vehicle ............................................................................................................................ 67.00 <br />Pumper Track 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 />Name of Applicant (Please ~Pril~): '~ b '.S ~ ~d9~. ~. ~'~t~ bit C ~, <br />Signature of Appiican,:t .~_,4~ ~ 4.~/..~~ Date' <br />~c t~-st ~ '"'t ' c , / ' <br /> <br />Receipt:. <br /> <br />Test Holes Ready: 7--' C~ ~' t~ 7 <br /> Date <br />Tank Pumped: <br /> Date <br /> <br />Pumping Certification Atlached: (Y) (N) <br /> <br /> <br />