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ReceivcdBy: __ 285 Chmch St. ICE- Pwom132 [Zon, ing Validation: -- ~ or~,o~ 97301 ~ s:~..~.~o,..~., s~m~ JUN ~ ~' ,nne [Dam: 24hr. Ias~-~to~Llae~-7~4 ,~/- //~ I ~ IO~U S~E EV~UA~ON ~/OR SE~IC PE~ APPI.I~A~M MARION .............. 'BUILDING INSPECTION 1. LOCATION OF INSTALLATION 3. FEES ** F~ i~lude DEQ Sumlmr~ (S30,00) Site Ev~luatlon, Single F~ly ~U~, ~ lm ................................................................................................... ~20.~ Sim E~l~fi~ S~e F~ly ~11~ Site E~lm~ ~ ~ 10~ ~11~ ........................................................................................................... 320.~ Sim E~mfi~, Co~ Sim Ev~fi~ ~ ~ V~ .......................................................................................................................... 320.~ C~ P~t or C~ Major ~, ~ 1~ ~: S~ S~ ........................................................................................................................... 3~.~ ~ic Sy~ ....................................................................................................................... 21g.~ ~p~g Fill S~ ...................................................................................................................... 593.~ ~1 ............................................................................................................................................ 3~.~ ~ T~h ~ Sa~li~ ....................................................................................................... 382.~ E~~s~on S~m ...................................................... ~y W~ D~ S~ ........................................................... '] .......... : ........ 1 ~'~ ~d~t S~ ............................................................................................................................ 392.~ ~ Pit ................................................................................................................................. 312.~ ~ T~ ............................................................................................................................ 3~,~ S~ Sl~ ....................................................................................................................................... 3g2.~ Ti~ C~s~i~ P~k or Co~i~ Major R~, ~ 1 ~ ~ll~: ~0 ~1~ - l~0 ~1~ ........................................................................................................ 133.~ l~ ~1~ - 2500 ~1o~ ......................................................................................................... 133.~ C~i~ Stag ~ F~ ~ ~, M~ (~ o~y) .................................................................................................... ~30.~ S~glc F~y ~, ~jor ~ (~fic~) ................................................................................................ ~10.~ ~o~ ................................................................................................................................... P~ ~ F e~ V ~t .................................................................... ~7.~ ~~ F~ V~it .......................................................................... ~7.~ ~ No Field Visit ................................................................................................... ~ 17.~ ~1E~~ S~ .............. ~ ........................................................................ ~47.~ ~ E~o~ ~ S~ .................................................................................................... ~23.~ ~p or D~ S~n ..................................................................................................................... ~5.~ P~p~ T~ck P~ T~k ~on, ~ A~i~o~l V~icl, ............................................................................................................. ~.~ Sep~c R~on F~ ........................................................................................................................................ 25.~ S~c ~ ~ for which no f~ s s~fi~lly indicated .............................................................................................. ~.~ + $100/~00 gallons + $25/500 Dfllons + $25/500 salloos S MC 15-S1 R~vS/g5 ~/ ~/r~ / ' ' ~ Total: Test Holes Ready: