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[~ec~ved By: ~ [Zonit~g Validation: DEVELOPMENT CENTER Ch~h st. ~e - ~o~ m Salam, O~n 97301 8:00am~:3Opm Phone 58~5147 hr''I~p~fl°n Lhe 58s'79~ 0~ q7.~t ~.~! SH3g F~Ii~Ti~i~/OR SEPTIC PERMIT APPLICATIONMARiON COUNTY L LOCATION OF INSTALLATI ~q~_l~lll#g l#~P[ ~TION BI)II DIN~ iNSPECTION 2. CONTRACTOR INFORMATION Mailing Addr~s Phone No. Mailing Address Phone No. 3. FEES Site E~fion, Sin~ F~y ~ell~g, ~ lot ......................................................................................................... $320.00 Sim ~fion, R~I ~a V~ee .............................................................................................................................. 320.00 Co~ction P~it or Co~ial Major RepaY, f~ I~0 g~l~s: S~ Sysmm ................................................................................................................................. 382.~ A~bic Sysmm .................................................................................................................................. 218.~ Capp~ Fill S~mm ........................................................................................................................... 593.~ Evap~tion-A~o~fion S~ ............................................................................................. 218.~ ~s~ Dis~bufion S~ ............................................................................................................. 553.~ R~t S~ ............................................................................................................................. 382.~ S~d Filer System ............................................................................................................................. 703.~ S~pa~ Pit ......................................................................................................................................... 312.~ S~ Trench .................................................................................................................................. 382.00 S~ Slope ......................................................................................................................................... 382.00 Tile Dewat~ System ..................................................................................................................... 550.00 Cons~ion P~t ~ Co~ial Major R~, ov~ 10~ gallo~: 1000 gallons - 25~ ~llons ............................................................................................................... 133.~ Sidle F~ily Dwel~g, Minor ~r (~ o~y) ......................................................................................................... ~30.~ Sidle F~ily ~ell~g, Major R~ (~nfield) ........................................................................................................ 210.~ Al~ti~ .......................................................................................................................................... 378.00 ~ Audition, Field V~it .................................................................................................................. ~7.~ Au~o~tion, No Fiald Visit ............................................................................................................ 117.~ ~ual E~al~o~Al~tiv~ System .............................................................................................. ~7.00 ~ual Ev~on T~po~ar~p Mobile H~e .................................................................... i 83.00 ~1 Ev~fion, ~e Sys~m ..................................................................................................... 123.00 ~ or Dosi~ Sip~ ....................................................................................................................... 25.00 ~per T~k ~pee~on, F~t Vehicle ............................................................................................................................ 67.00 ~r T~k ~spection, Ea A~i~o~ Vehicle ........................................................... 40 00 ~p~c ~i~fion Fee ..................................................................................................................................................... 25.00 S~c Ins~tion for w~ch ~ f~ is speeific~ly indicat~ .............................................................................................. 40.00~ Signature of Applicam: ~ Date: $ + $100/500 gallons + $25/500 gallons + $25/500 galloas Receipt: ~,.~ Total: ~/'2 O0 Test Holes Ready: Pumping Ceaification Attached: fY) (N)