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FOR OFFICE USE ONLY MARtON COUNTY BUI <br /> <br /> g,00 e, m,-430 pm Phone ,q8~1-$147 <br /> <br /> DWELUNG/STRUCTURAL ANr)/OR <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />cD OFFICE USE ONLY <br /> <br />RESIDEN'IIAL COMMERCIAL <br />[ ] NPwSFDw/garage [ ] Acc~ao~ [ ] New [ ] Sign <br />[ ] Ne~ SFD w/o garage [ ] Rclocat~ [ ] Addillon [ ] Demo <br />[ ] Add[t[oa [ ] Demo [ ] Alteration [ q] Other <br />~ Alteration [ ] Other [ ] Ola~lge./Occtq:~mcy <br /> <br />2. Location of Installation <br /> <br />S~bdiw~[on .... J .... ~[ glock .... <br /> <br />lx~kl~ " Acres ling Imt Come/" Pdvat*We~ [ ] Spring <br /> Commtmit~Well [ [ City <br /> <br />3. Contractor Information <br /> <br />4. Septic Information (Check where applicable) <br /> <br /> l'e~ holes Read~ [] Will Call Whe~l Test Ilolc~ Ready <br /> <br />[ ] Oilier. <br /> <br />5. Fee Schedules <br /> <br />A New' One-and-Two Family Dwclllng Cod~ Valuat[oll: <br /> (i~cl~([~ El, Mc, <br /> <br />(l)Sq Ft x 28 =__ <br />(2) 5% State Surcl~'arge (05 x Al) = __ <br />O) Ba~c Fee for Plan Revie~ = 1 <br />(4) Zoning Somhargc (If Applicable) = <br /> Subtotal: 5 ..... <br /> <br /> El. Me,, PI are separate permlt~ ) Yalua0on; <br /> (1) Pe Fee <br /> <br /> (4) Plans Check (6~ x Bi) ~ <br /> Subtotal: <br /> <br />C,, Septic Fees ~dudcs DEQ Su~a~e) (I) Site Evaluation <br /> ¢) New Septic ~ation Pe~t[ <br /> O) Au~od~ll~ Nmlee <br /> (4) ~i~ting System Rcp~ <br /> (5) Mg~ Re~tr <br /> Mitl~ R~ir (~nk mly) <br /> <br />Subtotal: $.~__ <br /> <br />D, Miscellaneous Fees (1) Driveway w/curb @ 5750 <br /> (2) Driveway w/o curb @ 517,,00 <br /> (3) S/re Plan Review (mere[a[ on[5) <br /> (4) Investlgatic~ Fee <br /> (5) Rem~pectlon Fee @ 52500 <br /> (6) Other inspcctiom not listed above <br /> <br />'l'otalt $ /.-~.~.~ <br /> <br />Receipt:: <br /> <br /> <br />