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MARION COUNTY BUILDING INSPECTION
<br />
<br />OCT 2 L 1994
<br />
<br /> MARION COUNTY
<br /> SITE EVALUATION AND/OR SEPTIC PE~IT ~PLI~ON BUILDING INSPECYION
<br />. Location of ln~talla~o~
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<br /> ~g,i!~ Evalual;on, fi~ 1000 ga, D~? ~45]01 20,00'
<br /> S.i,~ P~vMoa~ion ~a. add,!. ~00 ~a DSF 75.00 ,,,,20,OOJm
<br /> -- Coagmcdoa &, Repu r P~anit~ ' '
<br />
<br /> .... SZanda~ y~ mo~ ,th~ ]~0 ~I, D~:
<br /> Orav Water ~a~e D}sposal~ [ 1~ 00 "' 1,0.~
<br /> ~9~din~ Tank 2~5.~ I0.00
<br /> Redundant 5y~m ~45,~ ,1,0.~
<br /> 8~.d Filmr ~s.oo moo
<br /> Seepage T~'b 245.00 ,I0.00 ,,
<br /> 'rile ~qwatcdng sv~m .... ~5000 ,,, 10-~ ........
<br /> ~An Review
<br /> ~or e~h ~dit;ona1500 gal, D~F 25.~ ,
<br /> ~kcn(ions , , ' .... a4~.O0 ZO.O0 "~
<br /> Coasta,ct pa Pe~h RoO~Wa ~;~M ~s, ~) 150.00
<br />~onmmc~ nPc~I~,ae~¢WaI~oFleI~Vs s) 8$,~ 10.00
<br />A~tbOHy~ion ~ofice (FIJId Visit~ , 1 $0,~ 10,~
<br />~uthaffgatlon No?o ~0 Fi~l~,Visit) ,., g~0
<br />,, Aa~ya~ Evalu~ Oa of ~e Sys~m ~?00 10+00
<br />~Ck Info,on, F ~ rock 50.00 .~ [
<br />
<br />( ) 3'eS[ lq01gs ar~ Dug
<br />( ) [ will call whcll Tea }Io1¢.~ D~g
<br />
<br />( ) I am a registered bu[Idor or ( ) ibc autho~-cd mpms~oLafiw
<br />
<br />266-7223
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<br /> 5i~ EValuatio~, fi~ let 245,~ 20,00
<br /> Site ~v~l~ig~, eg. ~dl, lot 20~.00 20,00
<br /> Con~tloa pe~t
<br /> ~zrd ~e~ 245.00 lO,90
<br /> ~pping }'ill ,,, 41 $,00 1 ~.90
<br /> DJa~os~l,~mnch ia ~[~ 24~.00 10,00
<br /> G~y Wa~r Disposal Sq~ 12o.o0 10.00
<br /> .. Holdin~ Tank~. 245,90 10.0o
<br /> P~are Db~fi~utlon ~0.00 10.00
<br /> Redundant ~ ~45.00 10.0~ ,
<br /> ~epa~ ~n~h ~45.0Q .... 10.00
<br /> ~le ~a~ ...... ~,00 10,00 ....
<br /> ~Rem~oa ~45,0q .... ]0.o0
<br /> ~airr Major ~minffeld) 115.~ i0..~
<br /> g~r.~aor (an~), 7100 10.00
<br /> Constmetloa Pe~it Renewal ~cld Villi) 150,00 10.00
<br />~on~mcdoa Pe~}/Rqne~l ~o~d V~Jt) 85~ 10,00 ,,
<br />~ytbofi~fion N0~CC ~ield V sit) ~O.O0 I 0,~
<br />Fg~mg System ~val~at'on l ~0.00 1,9.00,,
<br />Aaa~ Bvalua/io~A/~m~iv~'gy~ 1~0,00
<br />Annual ~u~io~emp. o¢ H~bip MH 90,00 ,00
<br /> gu~A~ane~ ~te Ev~u~ba 24~,00 20,OJ."', ,
<br />
<br />NAME OF APPLICANT (please pilut)~
<br />$1GNAT61~OFAPpLIcAN'T: DAT~: ~ ~
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<br />MC 15-SI REV 2/93
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