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r0rt orr~c?~q~§ ~ost~ MARION ¢ote~r~ Btrn.n~G ~S~OS
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<br /> ..... ,,,,,,,,, , : Cod~A-~ee
<br /> ~ s~-~ BUILDING iNSPECTDN
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<br /> SI~ EV~UA~ON ~/0~ ~IC ~ ~PLICATIO~
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<br /> Sit~ Ev~luation,~ fiT*{ 1000 g~, ~ 245.~ 20,00
<br /> Si~5.',~y ?~uatlo., ca, ad,dl. ~00 gal, D~F 75.00
<br /> Gray Wa~e~ ~l~e ~osa[,~mp [~p.~ I0,00
<br /> ~%ud Filter ~.00 .
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<br />~F~_ ~,~ Io.~ ....
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<br /> ~ 'on Pe~ ,,~,ewa/~o ~eld V ~' ~) 85.00 ' I0.00
<br />~gxis/ing Sya/em E,valuufion ~pofl 150.00
<br />Atgh0tizati0~ N0tlee (Fkld Visk} 150.00 10.00
<br />' ~E~al ?~{uafionofAIl=mativ~m 150,~ 10,00 ,,,
<br />pu~por Track ~n~cctlou~ ~ track .50 00 ,00
<br /> ~,mpe~ T~ ]n~ec6ou, ~,, ~d{. t~ek ' 35.00 · ,00
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<br />(Mark l f App/leabl,~' to this Appli,~atlon)
<br />( ) T~at Holes ar~ Dt~8
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<br /> ) I am performing work on a pzo!oeay I own et oouupy
<br /> ) { am a mgisiemd builder or ( ) Ibc authofi~8 ~p~u~ive
<br />~ 'lira work will be p~ff0~ by a DF~ Liccaaed In.lief
<br /> )Other
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<br />R~ido~tial ,q~, ,,
<br />~i~ ]~valualion~ fil'~ lot 24~.0,0 20,00
<br />~i~ Evaluatio~ e~ ~dl. ~ 205,00
<br />M~nda~ Sy~m 2~5.00 10,~
<br />~p{n8 Fill 415,00 1O,~
<br />~olding T~k 24~.~ 10.~
<br />~a~ D{~%uti~ 3 ~0.00 10,00 ,_,
<br />"{'ia~.~, '" ,= , ~s.oo ~o.oo
<br />=~a~d ~}t~,{ , ~.00 i0.00
<br /> ~p~ Trench ~ 24~.00 10.00
<br /> R~pair~ Major (dmln~]d} 115+00 10.0
<br /> ~paJr, Minor (~nk) . 75,~0 10,00
<br /> ~e~t~ction Fe~lt ~newal.,(rt~14 y}dt) ] 50-00 lq.00
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<br /> ~uthofizatIo~ Notice ~ield ylgit) ', i 50:00 10-00 .....
<br /> buthoffzati~n N~e (No Fi~8 Visit) ............ ~$-O~ 1~-~3? "
<br /> ~i~fii~ gy~m Zva~u~a ,,,., ,, , ~S0,00 moo
<br /> ~nual ~valuatioWAllemative 8yaem 150.00
<br /> Annul BvaluafiO~mp. or H~hip ~ 90.~
<br /> Real A~a V~aa~ Sit~ Evaluation 245,00
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<br />NAMI~
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<br />MC IS-SI REV 2/93
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