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,~.OR CITY USE ONLY IRe~i'~ed By: __ IZoning Validation: [Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St. NE - Room 132 Salem, Oregon 97301 8:00am-4:30pm Phone 588-5147 24 hr. Inspection Line 373-4427 FAX 588-7948 MARION COUNTY SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATI~{~iU|N6 INSPECTION 1. LOCATION OF INSTALLATION Su~ivision ~t BI~k No. Employees Existing No. ~s~ No. Beams Bedims S<fion ~ TownsMp /~ ~nge C~ Zone ~ I Map/o ~ Wa~rSu~ly: ~vate Well ( ) Spring ~tWid* 7~ LotDepth /~ Acres ~/g ~eg. Lot ~/~ Comer ~/~ CommunityWe]l () Ci~ 2. CONTRACTOR INFOR~TION AO/a' r 3. FEES ** Fees include DEQ Surcharge ($g0.00) $ 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/gai Site Evaluation, Rural Area Variance .............................................................................................................................. 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 Saprotite .............................................................................................................. 382.00 Evapotranspiration-Absorpfion 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 Dewatefing 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) ......................................................................................................... 130.00 Single Family Dwelling, Major Repair (dralnfield) ........................................................................................................ 210.00 Residential or Commercial: Alterations .......................................................................................................................................... 378.00 Permit Renewal, Fie]d 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 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 Ralnspecfion Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no lee is specifically indicated .............................................. 7}~:~2'~'"' ................................ 40.00/hr ,/~/1~_~ ~, ,d' // ~. Receipt: NameofA h t/~/--~ pp 'cant (Please Print): 6.,A?}'~T4~.~ /~O~L.~t~'~ Signature of Applicant: /~tt~ ~ Date: + $I00/500 gallons + $25/500 gallons + $25/500 gallons Test Holes Ready: Date Tank Pumped: Pumping Certification Attached: (Y) (N)