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R~ce~e~ ey; -,~,~-' MARION COUNTY BUILDING INSPECTION <br />City <br />Z~Val~: ~- v,_~ .~ ~h~ <br /> <br />gUILDING [] <br /> <br /> City Setback Require~nta; <br /> <br /> J Fr~lt: Rear; <br /> <br /> __ <br />MOBILE HOME [] SEPTIC [~ERMIT APPLICATION <br /> <br />Amhtteet/Engimmr: Phone: <br /> <br />Septi~ Inslalletl~: <br /> Site Evaluation <br /> <br />Test Hole~ Ready.:' <br /> <br /> Existing ~eptl~ System: <br /> Existing Tank ,Size:, <br /> Exh~!ing Ol'ek'dteld <br />......... Type of Sm: <br /> <br />Date Tank Pumped: Exlatlt~l BedrOoms; <br /> <br />U~ of iaulldi~9: <br /> <br />Sq, r-t. Garage] <br /> <br />Valuation: <br /> <br />RES <br /> <br />Other; <br /> <br />Supply: <br />$. <br /> <br /> Bldg, <br /> <br />Mcxblle Home Fee; <br />~eteet $ureharge: <br />Zonktg Surcharge; <br />State SurCharge; <br />Plans Check Fee: <br />Site EvaluatiOn Fee; <br />~eptlo Permit Fee; <br />DEQ E;urcharge: <br />'l~hnica[ Revmw Fee: <br />Reinapeeti0n Fee; <br />Investigation Fee: <br />City Fee: <br /> <br />'FC~AL FEE; <br />RECEIPT NO.; <br /> <br /> <br />