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1. Locatie~ of Installation <br /> <br />_2. Coetractor ][uformatioq <br /> <br />3. Fees <br /> <br />~9~nmercial. {DSF - Daily Sewa~,e Flow) S <br />_~on~tmcfion & R~air Pcmi~ [ <br />Standard ~m 1~ ~an 10~ ~ O~ 2~$.~ I0~ <br />~ 44~,00 10.00 <br /> <br />~{~1, DSF.< 00 ill DSF 100,~ -00 <br />....... C~LTER~ <br />For each ~ditlv~ O0 <br /> <br />R~ air Minor '75,~ 10~. I <br />~,9n~tm~tion 'P~it ~aew~ (F~ V ~l~) 150.00 10.~ <br />' ' ' ~.oo <br />2C~~~ Sv~ ~o~o0 ,, to~,, <br /> <br /> · 'l i ' y .......... <br /> =l{ile ]gv~uafion~ firs~ lot "~45.00 ,20.00 <br /> $~ Ev,da,~alo,~, ~ ~d{, I~ 2o&oo .... 2o.oL <br /> <br /> ~s~ ..... ~.oo,,,, ~,. <br /> ~tn~ ~ 415,~ 10.00 <br /> ~y W~!~ ~ .... 120.00 ~o.~ <br /> 2~t ...... ¢4~-~ w.oq, <br /> ~ ~u~ ... 35o.~ ~o~ <br /> .. ROun~t 245.00 10.00 <br /> ~ ~i~ ,, ~ 4a~,,.,~ lo,oo <br /> ~p~ ~ ............ 245, oo Io.~ <br /> ~ev ~op* 245,~ 10.00,, <br /> <br /> Ah~on ....... 245,00 10,0~. <br /> <br />~,~or(~nk) ..... 7~,oo io.oo <br />~a~i~ pm~it ~a,~ ~ ~ld Visit) sS,~ ~ 0,00 <br />: ~e~o~on F~ 2~.. 00 ,oo <br />. ~h~ S~ ~al~n 150:00 10.00 <br /> <br /> ~ g~o~. or ~,~ ' 9o,oo .o~ <br /> ~ ~Va~e $i~ ~n I 245100 2~6~ <br /> <br />of~e $tate of Oregon and t~ ordinances o f IVladO~ County. <br /> <br />NA,.ME OF APPLICANT (pleaae print); <br />$iGN~tJ~E OF APPLICANT; DATE:~- <br /> <br />MC 15-SI REV 2/93 <br /> <br /> <br />