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· FOR CITY USE ONLY Received By: __ Zoning Validation: IDate: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St. NE - Room 132 Salem, Oregon 97301 8:00am.4:3Opm Phone 588-5147 24 hr. Inspection Line 373-4427 FAX 588-7948 SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION L LOCATION OF INSTALLATION Subdivision Lot Bilk No. Employes ~mo, 32 Tomhip 3 ~ ~g* I ~e Zone Map WamrSupply: ~va~WeB ( ) Spring ( ) ~t Wi~ ~ ]~ ~t ~p~ Ac~ l~g. ~t Co~r ~mmunity Well ( ) Ci~ ( ) 2. CONTRACTOR INFORMATION ~0 nUth~a~ gt o;nB u sin e st/L~s Name & Numbdr Mailing Address Phone No. Phone No. Phone No. Mailing Address 3. FEES ** F~s haclud¢ DE~ Surcharge ($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 gal ons ...................................... 320 00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal Site Evaluation, Rural Area Valance .............................................................................................................................. 320.00 Construction Permit or Commercial 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 Evapotranspiration-Absorption System ............................................................................................. 218.00 Gray Water Disposal Sump ............................................................................................................... 190.00 Pre,ute Dish'ibufion 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 l)ewatering System ..................................................................................................................... 550.00 Consteuction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee Commemial 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) ......................................................................................................... 130.00 Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 Residential or Commercial: Alterations .......................................................................................................................................... 378.00 Permit Renewal, Field Visit ............................................................................................................... 227.00 Permit Renewal, No Field Visit .................................................................................... 115.00 Authorization, Field Visit .................................................................................................................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 Existing System Evaluation ............................................................................................................... 247.00 Annual Evaluation/Alternative System .............................................................................................. 247.00 Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183.00 Amaual Evaluation, Large System ..................................................................................................... 123.1X) Pump or Dosing Siphon ....................................................................................................................... 25.00 Pamper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 Pamper Truck Inapaction, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Reinspaction Fee ................................................................................................................................................. 25.00 Sept c Inspection for which no fee s spec fica y ndlcated .............................................................................................. 40.00/hr + $100/500 gallons + $25/500 gallons + $25/500 gallons Name of Applicant (Please Print): Signature of Applicant: Date: Receipt: Total: Test Holes Ready: