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MARION COUNTY BUILDING INSPECTION <br /> <br /> ~ ~ ~ NE <br /> <br /> 1~4 MI~ ~147 <br /> ~P~ 4~ R~ - ~ ~ <br /> <br />MOBILE HOME [] <br /> <br />Phone: <br /> <br />SEPTIC [] PERMIT APPLICATION <br /> Ma~?g Add_r~: . ~ . <br /> <br /> Site No.; C~,~ Street; <br /> <br />Lot: <br /> <br />AtohitectlEnglrmer: " ~.. <br /> Phone: ~ A(Jdres~: <br /> <br />Tyoe of I:~rmit: New: ~ AddRIom [] Demo: [] Tach. <br />0.~14'~.'Tl~44./.'T. Alter: Ral0c~ation: ~ ~Chg,: ~ R~: ~ <br /> <br /> H~ ~ ~i~: ~. S~l~: ~. Ft, Maln P~r: ~. Ft, 2~ ~1~: <br /> <br />~ecl 8epti0 Ina:alia:iota <br />I;~r.,10us Site EvaJuat~x~ #: <br /> <br />~ of 8y~em: <br /> 'rest Holee Ready: <br /> <br />glee of ~ildir~; ........... ] RES ~' <br />~q. Ft, Gerage: ~ Other: 'T-e-r~L- <br />Oc=upsnt Load: Water SupI~y: <br /> <br /> Valuation: $ <br /> <br />Will caJI when ~ reaciy: Proposed Bedrooms; <br />Exes:lng ~ ~: <br />~a~ ~k Size: <br />EX~~ D~n~ <br /> <br /> D~ T~k Pum~; ~ <br /> <br /> Bldg. Fee_' <br /> <br />Mobile Honle Fee; <br />Fleet Sur0harge: <br />Zo.qblg Surcharge: <br />State 8umha~je: <br />Pleu'~ Che~k Fee: <br />Site Evaluation <br />Septic Perm~ Fee: <br />DEQ <br /> <br />Te~hnical Review Fee: <br />Reinspeetlon Fee: <br />Inveatlgation Fee; <br />City <br /> <br />'~OTAL FEE; <br />RECEIPT NO,; <br /> <br /> <br />