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FOR OFFICE USE ONLY <br /> <br />Cl~y Zonin~ V~ffdat,~n ~9 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE ,., ~ <br /> <br /> Code-A-PhS, r~.~8S.7904 a,~ <br /> <br /> FOR OFFICE USE ONLY <br /> <br />Left Side:; /~ .RIgh~ Side:: <br /> <br /> MANUFACTURED STRUCTURE & SEP'I'~I~I~Pv~CATION <br />[ [~ Si~eF~flyDwe~g [ ] O~ [ ] C~m [ ] S~ge ~ <br /> <br /> [ ~$ [ ] COM [[~New [ ] S~ge [ ]~c,~g, [ ] Reph~ment [ ]Techni~ew <br /> <br />COMPEi~: ,flJ. SECTIONS, 1 THROUGH 4 <br /> <br /> 1. Location of Installation <br /> <br />2. Inslallatlon <br /> <br />3. Septic Information (ChecA where applicable) <br /> <br />~ No Bedrooms Exmmg No, Bedsore& New hs~anca [] <br /> <br />Pr0~se~ Site ~valu~ ~ <br />T~t Hd~ ~ ~ W~ ~ ~ Te~ ~oJes R~y ~ <br />E~ ~m gv~ ~ ~ Sim Bv~u~ No;; <br /> <br />Exis~ng Se~c Sysmm ~ <br /> <br />4, Fee Schedule <br /> <br />A Each Mfg ~d Home or Modular Unit <br /> <br /> Each Mfg "d Home or Modulae Umt <br /> <br /> (1) ~otal of Above Fcea ~.~ <br /> (2) 5% Sta~ Surcharge (05 x Al) ~ / 0 <br /> <br /> Subtotal ~ $~1 <br /> <br />B Mfg 'd Structure Storage Fee 2500 <br /> Mfg 'd Stmctum Storage Renewal 25 <br /> <br />II I~vest/gat[on Fcc (if requited) <br /> <br /> @ $4000 per hour [2 hour mm ) __ 40 <br />K Cxty Fee <br /> <br /> TOTAL AMOUNT DI3E <br /> <br /> ECE rrNO q,fl. q P' <br /> <br /> <br />