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· ; FOR cITy USE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 285 C~r*b St. NE - l~uom 139 <br /> <br />,/Z6ning Yalkiation: <br /> <br />1. LOCATION OF iNSTA3LLATION, <br /> <br /> f.~,.xs~-?~,s TIO" MARION COUNTY <br />$1T'E EVALUATION AND/OR SEPTIC ~ APPLIC~ ~UI~ING INSPECTION <br /> / <br /> <br />Pdv~c W¢I ( ) Spring <br /> <br />~L. CONTRACTOR INFOILMATION .... , <br /> <br />3. ~E~ , . : $ .,-- <br /> *.~u~ . ' ' · ' ,,.$3~.~ ........ <br /> <br /> Cons~cfion ~it or <br /> <br /> Cons ~c on Pe~'~ Or Comm~ M Major R~r, ~ ~ ~, <br /> ~n ~t ~ + $~15~ gallons <br /> <br /> : :::" · ' ~'¢1o~ - I~ ~B~ ..................... ......_..:.L.:_ .......... :..-' .......................................................... 135.~ · <br /> <br /> r , 78 00 <br /> Commercial Mi~r Re ,: ............................................................................................................................................. <br /> Sine F~ily Dwcllln~ Minor <br /> <br /> Annual ~vatu~'on Tm~p Mo~'~0~ ................................................................... 188,~ <br /> ~m~ Tmo[ ~s~a. ~ Ad~fi~al Vchlcl¢ ............................................................................................................. ~,00 <br /> <br /> Nam~ of Applic0m fP~ Print): ~&~. ~ ~~ ~ Tear Hole: Ready: <br /> <br />Tnn}: Pum F, Cd'. <br /> <br />Pumpiug Cer~kficatioa Att ached', ('0 <br /> <br /> <br />