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IFOR CITY USE ONLy MARIONcCo~O~.U'~TrrYYDEB~UELIoL~D~I:~ ~NTGcJ~N, ES~PECTION <br />Zoning Validation: 8:OOam-4:30pTM Phone 588-5147 <br />Date: 24 hr' lnapCCfi°n .Line g88'7904 <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />~tWidth qO LotD~ 150 Acres . ~} I=g,~ C~er CommuaityWoll ( ) City ( ) <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />} Properly Owner <br /> <br />3. FEES <br /> <br /> ~* Fees include DEQ Sumharg¢ ($30,00) $ <br /> Site Evaluation. Single Family Dwelling. first lot ......................................................................................................... $320,00 <br /> Site Evaluation, Single Family Dwelling, ea addl lot .......................................... .~ ......................................................... 235,00 <br /> Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320,00 <br /> Sit* Evaluatloa, Commer¢ia11000 - 5000 gallons ................................................ ~ ................................... 320,00 + gaO~SOO/gui <br /> Site Evaluation, Rural A~ea Variance .............................................................................................................................. 320,00 <br /> Construction Permlt or Commercial Major Repair, first 1000 gallons; <br /> Standard System ................................................................................................................................. 382,00 <br /> <br /> 1000 gallon* - 2500 gallons ............................................................................................................... 133.00 <br /> <br /> Alt~tafions ............................................................................. il ........................................................... 375.00 <br /> <br /> .,.'~'fi~r~zatlon Field V~mt ......~ <br /> <br /> Existing System Evaluation ....................................... ............ ~- -..-.- ....... 247 00 <br /> Annual Evaluation/Alt*raatiw System .......... .................................................................................... 24?.00 <br /> Annua I~va nat on Temporaw/Hardsh p Mob e ltom¢,,,,,.;,,; ......................................................... I $3,00 <br /> Annua Eva nat on, Large Sys em ................... .;.; ......................................................... 123,00 <br /> Pump 0r Dos ngg phon ............ : .......................... .2!, .......................................................... 25,00 <br /> Pumper Truck Inspection, First Vehicle ............................................................. ;;,i ........................................................... 67,00 <br /> h~mper Tmek Inspection, l~a Additional Vehiol~ .............................................. ;.,~ ........................................................... 40,00 <br /> Septi~ Reinspection Fee ......................................................................................... <br /> Septic Inspection for which no fee is specifically indicated ............................... i~.: ........................................................... 40.00/hr <br /> <br />MailiagA0cl~ss 5pdMIL .~ A~)~J ~ I P~neNo~&~ ~ ~o'4 ;~ <br />Mailing A~resa Phone No, <br />Mailing ~f~il Phone No. <br /> <br />+ $100/500 gallons <br /> <br />$25/500 gallom <br />$25/500 gallons <br /> <br />Name of Applicant (Pleas¢ Print): <br /> <br />Signature of Applicant: <br /> <br />MC IS=SI RevS/95 <br /> <br />Date: <br /> <br />Receipt: <br /> <br /> Total; <br /> <br />Test Holes Ready; <br /> <br />Tank Pumped: <br /> <br />Pumping Cc:rrifictuion Attached: (Y) (N) <br /> <br /> <br />