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:~R O~SE ONLY <br /> <br /> DWELLING/STRUCTURAL AND/OR SEPT[C-PER~,'I['~PLICA'rlON <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 ~l~(}~ ~f~ ' <br />1.:.Job Description ~,~itJ)~l~ t~tr~[°~ <br /> <br />MARION COUNTY BUILDING INSPECTION FOR OFFICE USE ONLY <br /> 22,0 High Street NE <br /> <br />2. Location of Installation <br /> <br />Su~ivi~oo ' ' J ~ ~t BlaCk <br />~ ~ ........... ~0, ~ ~mayw~n [ ] City <br /> <br />3. Contractor Information <br /> <br />- 5. Fee Schedules <br /> <br />A.. Nm~ O~-m~t-'i~vO l%m~iy Dwelling C, udv <br /> (in~u~k.~ RI, J~, Pi) <br /> <br />4. Septic Information (Check where applicable) <br /> <br />I agree to t~tld ~cco~i~ ~o thc ml:,cnitted pha~ a[,~l SlYe, cifica ilea% the law~ of <br /> <br />Straclnml Permit <br />OPergmt fee det~m~gd by valuati~. <br /> <br /> 3% ~a~ Su~h~c (,05 x R 1 ) <br /> ~mg Su~rge (05 x <br /> Plans ~e~ (,~ x ~ 1) <br /> <br /> <br />