Laserfiche WebLink
FOR OFFICE USE ONLY <br /> <br /> DWELLING/STRUCTURAL <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. Job Description <br /> RESIDENTIAL ~Acc ] New SFD w/garage [ <br /> { ] New SFD w/o garage [ ] Relocat~ <br /> [ ] Additinn [ I Demo <br /> [ ] Alteration [ ] Other <br /> <br />MARION COUNTY BUILDI ~N~'~q. ~ ~..S~ .~_TION ,, FpROFFICE USE ONLY <br /> 220 H,gh Slr oI b- H <br /> <br /> 8:00a.m,-4:30p,m, Phone588-5~7~'iT' ~ ~ , ' <br /> <br /> FAX 5~-7948 <br /> AND/OR SEPa¢'~I~LICATION <br /> <br />COMMERCIAL <br />[ ] New [ ] Sign <br />[ ] Addition I I Demo <br />[ ] Alteration [ ] Other <br />[ I Change/Occapanc~ <br /> <br />2, Location of Installatlon <br /> <br />LmWidm~-:~'")" ~[D,m ~D / Acre~ r~g.~[/.r~ ....... Conler/[z~t/ PrivatcWell [ ] Spring <br /> Commmri*yWe~ [ } City <br /> <br />3. Contractor Information <br /> <br /> Atlth. Agent/teepee <br /> <br />Mailing Address & Phone No, '~ f' 7 <br />Malllng Ad&eSS & Phone No./Z~i(/~/~ <br /> <br />Co~tractor Business Name & Number Mailing Address & Phone No. <br />[/~LArchltect 'L XtJ~( Mailing Address & Phone NO, <br /> <br />4. Septic Information (Check where applicable) <br /> <br /> Proposed NO. Bcdroums: Existing No. Bedrooms: New Installation [] <br /> <br /> Test t[olcs Ready ~ Witl Call Whm Test IIolcs Ready ~ <br /> Existing Site Ev~uation ~ Existing Site Ev~uati~ No.: <br /> <br />Date Tank ~s[ ~m~: <br /> <br />Pum~ Foml Atlach~ <br />~ have rc~t this applimfion in its entirety ~d cem[ty that ~e stared info~ati~ <br /> <br /> · e law~ of <br /> <br />5. Fee Schedules <br /> <br />A. New One-and-Two Family Dwdling Code Valuation: $.__ <br /> (includes El, Me. Pi) <br /> <br />(1) Sq. Ft. __ x .28 <br />(2) 5% State Surcharge (.05 x A 1 ) <br />(3) Base Fee for Plan Review <br />(4) Zoning Surcharge (If Applicable) <br /> <br />Subtotol: S <br /> <br />(l) Permit Fcc <br />(2) 5% State Surcharge (.O5 x B 1) ~, <br /> <br />(4) I'hns Check (.65 x B1) q / <br /> <br />Septic Fees (Includes DEQ Surcharge) <br />(1) Site Evaluation <br />(2) New Septic Installation Permit <br />(3) ^uthofization Notice <br />(4) Existblg System Repor~ <br />(5) Major Repair <br /> Minor Repair (t~nk c~ly) <br /> <br />Subtotal: <br /> <br />(I) Driveway w/curb @ $7.50 <br />(2) Driveway w/o ctlrb @ $1 TOO <br />(3) Site Plan Review (commercial Oily) @ $79.(~) <br />(4) Investigation Fee <br />(5) Reinsp~:tion Fcc @ $25,00 <br />(6) Other inspcctlon~ not li~ted above <br /> <br />-- x $40 = . .... <br /> Total: $~4, <br /> <br /> <br />