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FO.R CITY USE ONLY MARION COUNTY BUILDING INSPECTI~-~f~-~V~r~. <br />- .. R~i~ By: ~ GO~DEVELOP~NTC~ I~ff I~ W/I~-~ ~1 <br /> 285Ch~hSt.~ - Ro~132 Jltl~ ~ ~ 1~ III J <br /> Salem, Omen 97301 aa ~//~J~l <br /> <br /> S~E EV~UATION ~/OR SEP~C PE~IT APPLI~ <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />Prope~ <br /> <br />Auth. Agent/Lemm <br /> <br />Mailing Address <br /> <br />PhoneNo. <br /> <br />PhoneNo, <br /> <br />PhoneNo. <br /> <br />3. FEES <br /> <br /> Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 <br /> Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 <br /> Site Evaluation, Commetcinl, first 1000 gallons ............................................................................................................. 320.00 <br /> <br /> Comtmetion Permit or Comme~ial Major Repair, first 1000 gallons: <br /> Standard System ................................................................................................................................. 382.00 <br /> <br /> Capping Fill System ........................................................................................................................... 593.00 <br /> Disposal Trench in Saprolite .............................................................................................................. 382.00 <br /> Gray Water Disposal Sump ............................................................................................................... 190.00 <br /> <br /> Seepage Pit ......................................................................................................................................... 312.00 <br /> Seepage Trench .................................................................................................................................. 382.00 <br /> S~p Slope ......................................................................................................................................... 382.00 <br /> <br /> Construction Permit or Commercial Major Repair, over 1000 gallons: <br /> <br /> Commercial Plan Review <br /> 600 g~llons - 1000 gallons ............................................................................................................... 133.00 <br /> 1000 gallons - 2500 gallons ............................................................................................................... 133.00 <br /> Conmmmial Minor P~-pair ............................................................................................................................................... 173.00 <br /> Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 <br /> Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 <br /> <br /> Altemfions .......................................................................................................................................... 378.00 <br /> Permit Renewal, Field Visit ............................................................................................................... 227.00 <br /> <br /> Authorization, Field Visit .................................................................................................................. 247.00 <br /> Existing Syatem Evaluation ............................................................................................................... 247.00 <br /> <br /> Annual Evaluation, targa System ..................................................................................................... 123.00 <br /> Pump or Doing Siphon ....................................................................................................................... 25.00 <br /> <br /> Septic Reinspectioa Fee ..................................................................................................................................................... 25.00 /~1. _ <br /> Septic Ir~specfion for which ~o fee is specifically indicated .............................................................................................. 40.00/hr t../.,--,"~~ <br /> <br />+ $100/500 galinns <br /> <br />+ $25/500 gallons <br />+ $25/500 gallons <br /> <br />Name of Applicant (Please~dnt): O.~L~'O [ ~ <br /> <br />Pumping Certification Atiached ~x~.]/ (iq) <br /> <br /> <br />