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i$OR OFFICE USE ONLY <br />P, evelvecl By: .... <br />Zolfing Validati°n <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 4'_t0 pm Phone fg$-5147 <br />Code-A.Pl~oae $g$-7994 <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br />Location of Installation 'w~ ,~"gl:Z't <br /> <br /> --C¢ieOIILgIIhaL(D.~' - Daily -t;ewa~re FI0w) " [ ii <br /> $24~$15 e~h adgL 3~ ~l. DaF 1~.00 <br /> Holing Tank ,245,~ ,,, <br /> ~ep~e ~.n~h 245 O0 10,~ <br /> Ste~ $1o~ 24500 lO,O0 <br /> ~etio a Pe~i/~n~wa] (Field y a~) .150.~ <br /> x~on~tloa Noilc¢ '~e/d V~it) 15030 10.'00 <br /> An~al ~lual on oi;Al~ive Syaem I SO.O0 1[.00 <br /> <br />_~per Tm~k l,~e~soa F ~t track, $0,~ .00 <br /> <br />) T~t l.[ol¢s at'i' Dug <br />) I will call when Teat <br /> <br />~e Family ,,. I <br /> 0" <br />Site ]~valuatioa, fl~ k,t : 245.0 20,0~ <br /> <br /> g~r, ~aor (~nk) 75.~ 10.0~ <br /> ~n~m~ti0a ~t ~new~ (Field ~s~t), 150.~9 10,00 <br /> A~I $v~u~iod~ve Sya~ 150,~ <br /> <br />NAMSOF APPLICANT (please print): <br />$IGNATIYRE O'F APPLICAYr: DATE: <br /> <br />MC I~-Sl REV :U93 <br /> <br /> <br />