Laserfiche WebLink
1. JOB DESCRIPTION <br /> <br />( ) Site Evaluation ( ) New Installation ( ) Alteration <br /> <br />Usa of Sh"ucture: No. Employ*es: Soating CapaCity: Total # Existing B~dfooms: Total # Proposed B~drooms: <br />2. LOCATION OF INSTALLATION <br /> <br />Subdivision: ~ i Lot: Block: <br />Map: { Zone: ParcelSize~ () SF () AC UGB:()Y () N <br /> <br />( ) I am the PI~PERTY OWNER and.own, reside in, or will reside in the completed structure and will be my own general conUactor. <br /> <br />· M~itiag Address: <br /> <br />4. FEES (Circle ~ AppropMate Fee) <br />A. SITE EVALUATIONS <br />Site Evaluation, Residential, first lot $ 335.00 <br />Sit~ Evaluation, Residential, ea addnl lot $ 205.00 <br />Site EvainaIion, Commercial, first 1000 gal $ 335.00 <br /> Site Evaluation, Commercial, 1000-5000 gal $ 335.00 <br /> <br /> Site Evaluation, Rural Area Variance $ 335.00 <br /> <br /> CONSTRUCTION PE~TS, for the tim !000 gallons <br />: pmj~ DgFi <br /> <br /> city: <br /> <br />AUTHORIZATION NOTICE <br />Field Visit Required <br />No Field Visit Required <br /> <br />Standard On-Site System $ 400.00 <br /> <br />ARemative System: <br /> Agrobic $ 400.00 <br /> Capping Fill $ 600.00 <br /> Cesspool : $ 400.00 <br /> Disposal Trench in 8aprolite $ 400.00 <br /> Evapotralmpiratlon-Ab sorption $ 400.00 <br /> Gray Water Sump $ 200.00 <br /> PreaSun~ Distribution $ 600.00 <br /> Redundant $ 400.00 <br /> Sand Filter $ 750.00 <br /> Seepage Pit $ 400.00 <br /> Seepage T~nch $ 400.00 <br /> S~ep Slope $ 400.00 <br /> <br />q-to3B 8 q-gq 58 <br /> <br />Zip: Phone: <br /> <br />Zip: Phone: <br /> <br />$ 250.00 <br />$ 90.00 <br /> <br />ALTERATION PERMIT <br /> <br />$ 400.00, <br /> <br />PERIVIIT RENEWAL <br />Field Visit Required $ 200.00 <br /> <br />the original pernflt~e ff an app~cafion for <br />ex~ da~. <br /> <br />SMgle F~ily ~ellmg, Major ~p~ <br />(T~eld or ~eld only) $ 200.~ <br /> <br />~le F~ ~eR~ ~m ~p~k <br />(T~ only) $1~.00 <br /> <br />Co~l~, M~or ~: ge~ ~Ns~Uc~ON <br />~ f~ fee <br />Co~ervial M~or Rap~ $150.~ <br /> <br />B. COMMERCIAL PLAN REVIEW (cost of <br />Plan Review is includ~l in permit for systems up <br />Io 600 gallons) <br />600 gallons - 1000 gallons $135.00 <br />1000 gallons - 2500 gallons $135.00 <br />thereof above 1000 gal <br /> <br />PUMPER TRUCK INSPECTION <br />Fimt Vehicle, each insp~cti0n $ 80.00 <br />Each Additional Vehicle, <br />each~on $ 45.00 <br /> <br />EXISTING SYSTEM EVAL $ 250.00 <br /> <br />RECORDS REVIEW $ 40.00 <br /> <br />Al. Enter Total Fees from Section 4A ~1 ~0; <br /> <br /> Tile Dewatering $ 600.00 D. Hourly Inspection Rate, $50.00/hour $ <br /> Pmnp or Dosing Siphon $ 25.00 ANNUAL EVALUATION . Total ~a~ouqt Due: ~,~ <br /> o.. $235.00 q,f:,6 UW -" <br /> For mot~ fi~an 1000 gallons:$400.00 <br /> + $40/500 gal or part thereof above 1000 <br /> <br />Phone: ~.~c~ ~q~ _ ~ .- I Certification attached? y / N [circle on,] Mcr~-St lt*v ~I~ <br /> <br /> <br />