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FOR OFFICE USE ONLY
<br />p.¢ceived By:
<br />zoning ¥~lidatloa , ,,
<br />
<br />MARION COUNTY B~.FI~Y~ING INSPECTION
<br />
<br /> S~m. Ol~0l
<br />
<br /> Ca&.A-PIm~ $85,7904
<br /> FAX ~g$-7948
<br />
<br />SiTE EVALUATION AND/OR SE]KTIC PER,MIT APPLICATION
<br />
<br />L L~c~tlo- of Installation .......
<br />
<br /> ~ .... ~; :~" ~'~Ck%~ ~ ~ IT~o.
<br /> [~o~l ~ I ~ ISz~*. ....
<br />
<br /> ~ubdi~ ~a ............... , .... ~ ~ ,,
<br /> ~b~a~ P=rk ..... I ~ · ,
<br />
<br />~o.
<br />
<br /> 3, Fees
<br />~,.Ollll~e~ei'a I fDS~' L
<br /> S t~ ~vs u~ o~,,~m t~O
<br /> sit. ~,,~ ~s. ~ ~,~ ~S,~ ~om;m ~ ~.1~ ~ ~l.~' ( ~:,,~' 20.00 ~,
<br /> Co~stmctio~e~ir ~B ~n~tio~ ~t
<br />
<br /> S~nda~ gys~m mom tha~
<br />
<br />: ~i~s Fg~
<br />
<br /> 120.~ 10.~ ~z~ ~%ufion 3~,~ 10.00
<br />}lo]ding ~k 245~ I0~ Red~.~ 245.00 10,00
<br />P~asu~ Di~u,ti.~ ..... 3~0~ 10.~ ~d NI~ ....... ~S~ 10,~ .....
<br />~8u,dant ~em ...... 24S.~ I0.~ .............. ~ ~h .................... 24~,~ 10.00
<br />
<br />~A~ Tm~h ................ ~4~,~ 10.~ ~ ,'~1~ ~w,~h~' ' ' 350,~ I0,00
<br />,, ~,{op $~ 24~.~ 10.~ ~ ~]~om ..... 245,00 10,00 ................
<br />~vi~w ~p~n ~uo[(m~) 7~.00 10,00
<br />
<br />~~) ,,, ,,, Co~metion ~t ~n~ ~o F~I8 Visit) g~ 10,00
<br /> (For =ach ~ditiqnal ~0 ~. DSF 25,~ ...... .~ R~o~tlo~ F~ ~5.~ .00
<br />
<br />~i~s~m ~alu~oa ~
<br />Auiho~tBn ~ot~c (~ie~ Vlsl
<br />_AutO,ti0, Not~e ~o Field V~t) g~ 10.~
<br />An,u~ ~wluzgoa 0f Aigrette Sy~m 1~0.~
<br />Annual ~va!~ ~ ~m
<br />~mper Tm~ ~n~,
<br />~mprr Track ln~l{o,z, o~ ~1. *m~k ~.~ . .~ ...........
<br />
<br />(M~¢k if Applie~kbl6 ~, ~bi$ Appli¢~on)
<br /> Tc~t Holes ~ Dug
<br /> will call whcz Tc~ Holo$ Dug
<br />
<br />) I am petformie, g work on a pmp~v~y ! own or occupy
<br />
<br />) ~ ~rk will be ~o~d by a D~ ~c~ l~f
<br />) ~ber
<br />
<br />0fthe ~ of Ore~n ~nd t~e ot*dJt~itces o f ~tr~On ~ounty.
<br />
<br />NAME OF AI'PLXCANT (please print):
<br />
<br />SIGNATURE OF APPLICANT: DATE:
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