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FOR,QFFIC~_ USE ONLY <br />Zoning ValidatiOn ff,~ ~. <br /> <br /> 0 6 994 <br /> <br /> BUILDING INSPECTION <br /> F~ 588-7948 <br /> <br />SI~ EV~UA~O~ ~!O~ SEP~C PE~T ~P~iCA~ON <br /> <br /> Contractor Information <br />PropeC~y Owner <br /> <br />Auth. Agen~a~e¢ { : : <br /> <br />Mailing Address: Phone <br />Mailing Address: ~ Phone No. <br />M~ling Addgss: ~/ , Phone:No. <br />~iling Add,ss: ~one No- <br /> <br />DEQ Licen~d Contr~ter & No. <br /> <br />Residential ginvle Familv <br />Site Evaluation. first lot 245.00 20.00 <br />Copst~ction pe~it <br />~pi~g Fill .~15,00 10.00 <br />Om~ W~r Di~ Sump 1~0.00 10.00 <br />Holding T~k 24~,00 10,00 <br />P~ssu~ Di~fibutioa 3~0,~ 10,00 <br />~d~deot ,2,45,00 10.00 <br />~nd ~}[~r 445.00 10,00 <br />Steep Slope 245,00 10.00 <br />~le ~watefin8 ,, 350,00 10,00 <br />~P~r, ~or (mak~' 75.00 <br />coaatmctioR Pe~it Renewal (Piel~,,V s 0 150,00 , 10,00 <br />Construction Pe~it,,Renewa ~o ~ · O~,,s t) 8~.00 lq,.00 <br />'Agth~tion Notice {F ~ d V s t) 150.00 <br />Authofi~a~igR Hot ce ~o ~.6. ~ V s t) . g 5.00 10..00 <br />~i~in~ Sys~m ~valua~oa.. 150.00 10.00 <br />Annual ~v~uatio~Al~matiw 8~ste~ 150.00 .00 <br />ARRua} Evaluatio~emp, or HaMship ~ 90.00 .00 <br />Rural Ama V~ance Si~ Rv~uatioa 245.06 <br /> <br />Other <br /> <br />(Mark if Applicable te this Application) ) Test Ho~es ar~ Dug <br /> ) I will call when Test Holes Dug <br /> <br />(~') I am a ~gistcred builder ot ( ) the authored mpm~n~ve ~ <br />(~) ~c work will be performed by a D~ Liccn~d Ins~lc~ <br />( ) Oih~r ~ <br /> <br />MC 15-SI REV 2/93 <br /> <br /> Receipt No. <br /> I agree to in~tall a~cording to the submitted plaus and specifications, the laws <br /> .of the State of Oggon and the ordinances of Marion ~oun.~ <br /> <br />NA.ME OF ~PL~ANT (pleas~ p~int): <br />SIGNATURE OF APPLiC~: DATE: <br /> <br /> <br />