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,FOR OInTICE USE ONLY <br />Received By: _ <br /> <br /> Date: .. . .... <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> <br /> 81L-ug 0~. 97~1 <br /> <br />8:00 Lin. - 4:~0 ~ 'P'aoae 558-5147 <br /> <br /> ~A.X ~:BS-79~S <br /> <br /> $IT~ EVALUATION AiqD/OR 5SlPTIC pERMIT APPLICATION <br /> <br />~o~,,.tt~ r,r~. .. " ..l~' ~t ] ~ <br /> <br />~CAt~er cial ~DS~ ~Dadv ~ ~) ~ R~id~ti~S~le Faintly <br /> <br /> Evalu~li0~, fi~ 1~ ~. ~F , 24~,~'" 2Q,~ ~to ~9~1 fi~ I~t 245.00 20-~ .... <br /> <br /> c~p~ ~ii~ ........... ~o~ ¢~Y w~ ~ t~.~ ~o.00 'l <br /> <br /> ~d~n~t SYgem 245~ 10.~ ~p~c T~h 245-00 10.00 <br /> <br />SI*pc .............. ~ 10.~, A~a 24L00 10.00 <br />~wac~nn~tcm ' ~ 1O.~,, ~r,~jor(dai~ld) I15.00 [ 10,00 <br />~eview R~ak, ~ao~(~k) 7~.00 [ 10.00 <br /> <br /> ~ ~D ~L~ ~a~ction ~t ~ ~o ~ld Visit] 85.00 10.00 <br /> <br /> Al~fls ............ 245.~ 10,00 Au~0~ ~Ofi~ ~ Vi~) lS0,00 <br /> Minor 75~ 10,~ A~o~ton H~e ~o ~el4 Vig0 85.00 <br /> ~.tt~Ctlon Pc~;~ ~n~l ffield Visit) !~0-~ 10,~ ~ng Sy~ ~v~n 150,00 l 0,00 <br /> <br /> Amho~ N~ ~M Visit) , { g,~ ,,, , 10.~ , ,,,,,,,,h~ A~ Vig~g ~ E~I~ 245,~ <br /> <br /> ~valu~ioa of Al~aiivm $ym~m l$0,~ <br /> Bvalusfioa of~r~ S~m ~.~ 10.~ ,, <br /> <br />(M~rk ifApplicab~ lo l~ia Appli¢~iOu) <br /> )'l'~;l }lol~s ag <br /> ) 1 will ~all ~,~a <br /> <br /> ~cclpt No. <br /> <br />of~ ~,ato of Ol~gofl afld ~ o~llnanc~$ of M,~On CA~ttatV, <br /> <br />NAME OF APPLICANT (please print): <br /> <br />SIGNATURE OF APPLICANT: DATE; <br /> <br /> <br />