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2~0 High Street NE <br /> ~c · ~ ~y; ~ --~ ............ ~m, OR 97~1 ~, . <br /> <br /> DWELLiNg/STrUCtUrAL ~flDlO~ SE~IC PE~iT APPLICATION <br /> <br />COMPLETE AL~ ~EGTION~ 1 ~OU~H 4 <br />~Job Descriptlo~ <br /> <br /> ] A~flklon I I ~o [ ] ~t~ [ ] O~er <br /> Ul~ ~ Buli~ing: ...................... <br /> <br />2. Coeallon of Installation <br /> <br />Contractor Information 6~, Fee Schedules <br /> <br />4. Septic Information (Check where applicable) <br /> <br />Tank <br /> <br /> ] I ~.av{ ~ 13i~ ~t~lia6~ iii i~ envy ~d ~y ~t ~c'~ ~o~ <br />~' } ~c work will ~ ~tf~cd ~ a ~gis~ ~l~. <br /> <br />A. New Onc-a.n~-Two Family DwcU~ng ~ <br /> (in¢lu~e~ Et,,M~, <br /> <br />Valuation: $ ._ <br /> <br />C- <br /> <br /> Sub{ot~l: $' ,,.,,,.~ <br />SgptlC ~s ~¢la&:s DBQ SUrfaCo) <br /> <br />(5) M~ ~ir <br /> <br />(3) Si~ ~an R~icw (~mcrcial ~ly) ~ $79.~ ~ ~ <br />(4) rn~ati~ F~ _--~ <br />O) R~n*~ Fcc ~ S~,~ = <br /> <br /> <br />