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FOR OFFICE USE ONLY
<br />ReCeived By: ............
<br />Zoning Validation
<br />Date:
<br />
<br />MARION COUNTY l~IYrr.~ING INSPECTION
<br /> 7 ~.
<br />
<br /> §,'~ a-re.. 4:30 pm Phon~/;llg-S 14'/
<br /> Codc-A-l~m~ 58//-7904.
<br /> 1AX 588-7948
<br />
<br />SITE EVALUATION AND/OR SEpTiC PERlvlIT AI'PLICATION
<br />
<br />of Installation
<br />
<br />Contractor Inform~L~
<br />
<br />Number ....... ~g Ad4~: ..... Phon~ No. "
<br /> ,',,'' i,<-' , ~AJd~', ~o6~No,
<br />D~Q,~t~c~ff C~t~t~ & No.'. · ". , ,
<br />
<br /> Commereml (D~ FI0w] i $
<br /> $i~ ~valuationz ca. add/. ~ ~l. D~ LI,~ ........... Y~'00.
<br /> C6ff~mctioh &~d~drP~its · ' ' , ' ,,' 'J ' " '
<br /> ~nd,~ ~e~ !~a~!~0 ~, DSF 245.00 ~0.~
<br />
<br />CnppingFi{[ 415.~ { 10.~' ~,
<br />}!~IOj0g Tan~ 245.~ ' I0.~
<br />steep ~[ope 14~.00 ~ ~o.oo
<br />
<br /> {For ~a~h addltlong 500 gal~,,.~,~F, 2~-~ f .00
<br /> Alt~z~t}on s 245.~ ' 10.00
<br />
<br /> tu~odz,ilon Not~ ~eld Vi~{0 ' :'1: 5'0.~ :i !~, ' '"
<br /> Pun pe[ I ~pact o~ ea~,,~,~],~ ,~ck '35.00 { ".~'
<br />
<br />(Mark [fApplicable lo this Applicatio ) , , . , , ,..
<br />Test I~ot~a a~ ~$ '
<br />I will ~sll when Te~ Holes ~g
<br />
<br /> Residential Single Family .........
<br /> 1~{~ ]~wlu~tion, tlmt lot 245.00 ~0.~
<br /> ~nd~ ~Aem 24~-00 1,0,~
<br /> ~Ming Tsnk. · 245_00 I0-~
<br /> ~m. Di~o~ 350.00 I0.00
<br />
<br /> ~p~e ~eh 245.~ 10.O0
<br /> ~ ~]opc 245,00
<br />
<br /> 'Al~ion ........ ~45 00 10 00 _
<br />
<br /> ~ctio~,~Jt Rental ~eld Vis[t) 150,00 ~
<br /> ~o~stmct on P~'t Rental ~o.F'~ld Vis/) 8~,00
<br /> ~ins~ou Fe~ 2~,00 .00
<br /> Authog~[o~ Not ce <~ ~ d V ~i0 150.00 10,00
<br />~f~o P;eld Viait 85,00 10.~,,
<br /> ~'~'ng System Evalu~ion 150.00 I0,:~
<br /> Annual ~Vfluatio~A/~at ~ Sya~ 150-00 I .00
<br />
<br /> NAlVIE OF APPLiC~ (please print);
<br />
<br />- S~NAT~ OF APPLiC~:
<br />
<br />DATE:
<br />
<br />MC 15-8I REV 2/93
<br />
<br />
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