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FOR O~FFICE USE ONLY MARION COUNTY BUILD~IN~I~J~ FOR OFFICE USE ONLY <br /> ~? /' 220 H~gh StreethF ~ ~ ~ ~ <br /> <br /> - ~ .'~ .... : , ,- : p, . e~8~5147~ .'~ ~// I ' <br />Oate; /~/~//?/ Code-A-Phone~-~/ "~ ~. //// ~ I <br /> ~ ~ ..... FAX 588-~/~ ~/OZ/ ~/ L~e; /~ ~ Right ~ide; /0 <br /> -- ~UlN~ " COn <br /> MANUFACTURED S~U~URE & SE~C P PLICATION <br /> <br /> Single Family Dwelling [ ] Off.tog [ ] <br />[~"/RES [ ICOM g.4'~Iew [ ] Stmage [ lO ce. Chg. [ ] Replacement [ ]Teclmic~lReview <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. Location of Installation <br /> <br />2. installation <br /> <br />4. Fee Schedule <br /> <br /> Item x Cost = Total <br /> <br />A, Each Mfg,'d Home ~r Modular Unit <br /> <br /> (I) Total of Abova Fea.~ $~, ~ <br /> (2) 5% $m~e 8~rch~e (,05 x Al) q- 1~ <br /> <br /> Subtotal $~&Le <br /> <br /> Mfg.'d Structure S~omg¢ Fge <br /> Mfg,'d Smacmre Storage Renewal <br /> <br />C, Site Evaluation Fa: <br />D. New Septic ~st~'xllalion Permit Fee <br /> <br />E, Authorization Notice Eec <br /> <br />F, Repair Permit Fee <br />O. On-Site '['¢¢hnical Review Fcc <br />II. Investigation Fee (if requi~d) <br />I. R¢inspecfion Fee <br />J. Other in~pections not listed above <br /> @ $40,00 pet hour (2 hour min,) <br />K. City Fee <br /> <br />TOTAL AMOUNT DUE <br /> <br />__ 40.00 ......... <br /> <br /> <br />