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BL <br /> <br />U~ of Bul~ing~ J RES <br /> .::,, <br /> <br /> 'wJu~ion' s ,/::~g.-.~ .... <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation #, <br /> <br />Test Hotas Read~:i <br />Will C~II when holes <br /> <br />Existing Septic Sy~,lem:: <br /> <br />S'GNATUREOFAP~ANT::~ ~ ~- ~/ <br /> REQUIRED ~ THIS OEPT,: PLUMBING, MECHAN~AL, ELECTRICAL <br /> <br />Bldg Fee. $ __ rT.T.>.~, ~-0 <br /> <br />MOt~ile Home Fee ....... <br /> <br />Zoning Surcharge <br /> <br />Septic Permit Fee <br /> <br />DEQ Surcharge <br /> <br />Rainspe~tiee Fee:: <br /> <br />levestlgahon Foe <br />City ~ee <br /> <br />TOTAL <br /> <br />R~OEIPT NO ..... <br /> <br /> <br />