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FOR OFFICE USE ONLY <br />R¢ceiwd By: ,, <br />Zoning Validation ~ <br />Date_' , - <br /> <br />MARION COUNr'i/' ]~UILDING INSPECTION <br /> <br /> 4:30 pea lqm~ S88-$147 <br />Code-A-l'ba~ $~8-7904 <br /> <br />SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br /> <br /> ~reet <br /> Block ~ <br /> <br />2 Contractor Information ~ , .... ,,, .... ' ..... <br />' M~g n~ Add~ ~ No. <br /> <br /> ~"~ Sy~*m <br /> + * <br /> D,~po~l T~ches m ~},~F 745~ 10,~ , <br /> ~ep Slope ~5,00 <br /> ~ an ~V e~ <br />......... }~ ~. ~.~t ~.~ ,t~.~ ,~ ..... <br /> (For ~ add,il~$1 <br /> Atte~f~ .................. 14~,~ 10.~ <br /> Authod~i~ N~ <br /> <br /> ~m~r Track Inaction, H~k ~,~ <br /> ~!~LTmck Ink'ion, <br /> <br /> if Applicable to this Appli~ation) <br /> ate Dug <br />) I will call wl~u Tesi Holes D~g <br /> <br />) I am perform/ns work on a.p~0p¢tl~ I ow~ or occupy <br /> I am ~ regialered builder dr ( ) the imthorlzed wprc~ntafive <br /> The, work will I~ perforated by a DI~Q Lie~nr~l Inalillvr <br /> Oth¢~ <br /> <br />· . R~¢* ptNo, <br /> <br />NAME OF APPLICANT (ple~s~ print): <br /> <br />SIGNATURE OF APPLICANT: DATE: <br /> <br />MC IS-SI REV 2/93 <br /> <br /> <br />