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............. iLY ~L~RION COUNTY BUILDING <br />t R~c~ived By: ~ I S~ OR 97~X <br /> <br />~ ....... ' ~ ) ' '~ ' ' ' Add~ <br /> <br />--~ ' .... ~_"~_ ,~"A% ~'~q~ ~ ~.~ <br /> <br /> M~te Ho~ P~k ~ /~:~ - ,~ ": .... I ~" <br /> <br />Sit~ Ev;d0ati0n, first 1000~aL DSF, "$; 2~,0 ;20~00 g <br />$t~dard S~t*~ JO-q tha~ 1~ ~al, DSF 2~.0 <br />~Stand~d Sya,m m~= ~, I~ Ssi. DSF: J <br />(e,x~¢ S~D FILTh) <br />~(l~)~ ioa Pernfit Ro~cw~ ~,~,e~ ~islB) 120.~ 10-~ <br />Exi~du$ S ~t~m E~Iuafion Re ~ l~P.~ 10-~ ~ <br />Annual B~al~ion ofAltctnadv~ Sysl~m , , , 120,~ 10.~ <br /> <br />0vh~k if Applicabla to ads A~pllcadon) , <br /> )'lEst Holes ar* D~g <br /> <br />) l sill pcrfc~mlng work Oaa property I own ~ ~eupy <br />) t am a mg~qt~r0d bu/Ic~r ~ ( ) ~* authmigd r~nmfi~ <br />~a registers4 build,r, <br /> <br /> r~b ~dl. lot <br />Cor~tructi~ ~mlt <br /> <br /> , Wat*r Dia~al,,$ump <br /> Tank <br />Prer~ <br /> <br />gand Filt~ <br /> <br />Annual Evaluatloa~AltqXnal !v~ System <br />Rt~ral Area Varia~eo gigs gvaluafon <br /> <br />SIGNATUR]~ OF~PPLICANT'. <br /> <br /> <br />