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· . i Flow~ $ <br /> Site Evaluaqon wst 1000 .DSF ........ ~45~ <br /> SiteE~lua6~,,~ ~l, 500 ~. DS~ 7~.00 20,~/m <br /> <br /> $~45 00 +$I5 ~ach ~d ~DSF 10,~ <br /> <br />~e~ated~ Sv~em i~O_O0 IO.~ <br />>600 ~~aLP~ t~ .oo <br /> <br />A~,,{}lo~iion Not i~ ~o Fk~d, Vhit) ,,,J 85,00 <br /> <br /> Pumper Track I m~tiE,0~,,~ a~,~,~,.~ 35,~ <br /> <br />(Mark if Appli~abb ~o this Appli¢-qQ¢) ) T¢~I Holes ~ DUg <br /> ) I will tall when Tesl Holes Dug <br /> <br />) 1 am a registered b~lild~r or ( ) thc authari:,.ed reprenantalive <br />) Th~ work will b~ l~ffunn~d by a DI!Q L[¢¢ n *,~q{ Iu*~ler <br /> <br /> $ <br />Site Fv~lu~ion~ fi~ lot ........ ~45.00 20,00 <br />S e Eva uallon, es- addl. lot ....... 205,~ 20.~ <br /> <br />~n~ Sram 24~.~ !0-00 <br /> <br />St~v Sl~ 2~,~ lO.OO <br />Alteration 24~,~ 10,00 <br />~pair, ~nor (~nk) 7L00 10.~ <br />Autho~Go~ Hot~e (~iald Visit) 150,~ !,0-,~ , , .................. <br />~ A~a V~ce Site ~{uatlen 245,00 20~ <br /> <br /> RuCelot Nc,. <br />I agree to inatall according to h~e aIbmltted plans and ~;peclflcation~, thc taws <br />of the glatt of Oregon and tho OI~illaGCeS Of IViado~, County. <br /> <br />NA,ME OF APPLICANT (please print): <br />SIGNATURE OF APPLICANT: DATE: <br /> <br />MC 1S-SI REV 2/93 <br /> <br /> <br />