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FOil, CITY USE ONLY <br />l~'ece~ed By: __ <br />]Zom?g Validation: <br />[Vat;i <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENT[R <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br /> 8:00nm-4:3Opm Phone 588-5147 <br /> 24 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 />~t Wid~ ~t ~p~ ~s ~, ~ ~ ~g. ~t ~r Co~ualty Well ( ) City ( ) <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />3. FEES <br /> <br /> ** ~ include DEQ Smcharge ($30.00) <br />· Site Evaluation, Single Family Dwelling, lust lot ......................................................................................................... $320.~0 <br /> Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 <br /> Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320.00 <br /> Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal <br /> Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 <br /> C~nsm~cfion Permit or Commercial Major Repair, fa'st 1000 gallons: <br /> · Standard System ................................................................................................................................. 382.00 <br /> Aerobic System .................................................................................................................................. 218.00 <br /> Capping Fill System ........................................................................................................................... 593.00 <br /> Cesspool ............................................................................................................................................. 382.00 <br /> Disposal Trench in Saprolite .............................................................................................................. 382.00 <br /> Evapotransplrafion-Absorption System ............................................................................................. 218.00 <br /> Gray Water Disposal Sump ............................................................................................................... 190.00 <br /> Pressure Distribution System ............................................................................................................. 550.00 <br /> Redundant System ............................................................................................................................. 382.00 <br /> ~ Sand Filter System ............................................................................................................................. 703.00 <br /> Seepage Pit ......................................................................................................................................... 312.00 <br /> Seepage Trench .................................................................................................................................. 382.00 <br /> Steep Slope ......................................................................................................................................... 382.00 <br /> Tile Dewatering System ..................................................................................................................... 550.00 <br /> Construction Permit or Con~nercial Major Repair, over 1000 gallons: <br /> Construction Permit Fee <br /> Commercial Plan Review <br /> 600 gallons - 1000 gallons ............................................................................................................... 133.00 <br /> 1000 gallons - 2500 gdilons ............................................................................................................... 133.00 <br /> Commercial Minor Repair ............................................................................................................................................... 173.00 <br /> Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 <br />· Single Family Dwelling, Major Repair (drsinfield) ........................................................................................................ 210.00 <br /> Residemial 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 Evaluation ............................................................................................................... 247.00 <br /> Annual Evaluation/Alternative System .............................................................................................. 247.00 <br /> Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183.00 <br /> Annual Evaluation, Large System ..................................................................................................... 123.00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br /> Pumper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 <br /> Pfimpor Track Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 <br /> Septic Reinspection Fee ..................................................................................................................................................... 25 <br /> Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr <br /> <br /> $ <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br /> <br />+ $25/500 gallons <br /> <br />FILE <br /> <br />Name of Applieant (Please Print): 1 ,'1l <br /> <br />MC IS-SI RevS/96 <br /> <br />Test Holes Ready: <br /> <br />Tank Pumped: <br /> <br />Pumping Ce~ification Attached: (Y) (N) <br /> <br /> <br />