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MARION COUNTY BUILDING INSPECTION <br /> COMMUNI'I~ D~V~LOPMEI~ ~ ~5 Church.~t. NE ~ <br /> <br /> g:~4~ ~ ~147 <br /> <br /> ~,x ~-?~ MARION OOUNIY <br /> SITE EVALUATION AND/OR SElrrIC PERMIT APPLICATION BIJILD/NG INSPECTION <br />I. LOCATION OF INSTALLATION <br /> <br />3, FEES <br /> <br /> Site Evalgation, Rll~ ~ea V~ .............................................................................................................................. <br /> Construction <br /> ~StandaM $yst~ ................................................................................................................................. 387.~ <br /> <br /> Capping ~ll S~:~m ........................................................................................................................... <br /> <br /> Dis~ Tmch ~ ~p~le .............................................................................................................. 387.~ <br /> <br /> Gay W~r Dis~al Sump ............................................................................................................... 195.~ <br /> Hol01ng Ta~tC~(__~a o~y) ...................................................................................................... 387.~ <br /> <br /> R~ant ~t~ ............................................................................................................................. 387.~ <br /> <br /> $~age Tm~h .................................................................................................................................. 387.~ <br /> <br /> Tile ~wat~ng ~ ..................................................................................................................... <br /> Const~cdon Permit 0~ ~iaJ Major Re.ir. ov~ 1~ g~ons: <br /> <br /> g I y Dwelh~. ~r ~r(~k Only) ........................................... laS,~ <br /> Pe~ ~W~, ~dd Vizk .................................................... ; ........................................................ ~2.~ <br /> <br /> Annug Ev~uaion, ~r~ Sy~ ..................................................................................................... 12g~ <br /> Pump or ~ing Siphon ....................................................................................................................... ~5.~ <br /> Pum~c Truck Ins~fion, ~ V*hlcle .......................................................................................................................... <br /> Pump¢r Track [ns~¢¢flo~ ~ AddMo~ V~ ¢ ¢ ................................................... 40 <br /> <br />Name of Applican~ (Plca~ Print): ~f~ ~ T~t Holes <br /> <br /> <br />