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~ co~rv ~w~O~M~r c~r~ <br />ReceivcdBy:-~ 28SChu~ehSt. NE-Room132 APR 7 - 1997 <br /> S~em, O~n 97301 <br /> <br />Date: ~[ ~[~ 24 hr. lns~flonLin. SSS-79~F~ 588-7948 MARION COUN~ <br /> SITE EV~UATION A~/OR SEPTIC PE~T APPLICATI~LDtNG INSPECTION <br />1. LOCATION OF ~ST~LA~ON ~ ~ '~q ~q <br /> <br />2. CONTRACTOR INFORMATION <br /> <br /> Property Owner <br /> <br />Mailing Address Phone No. [ <br />Mailing Address __. _ PhoneNo... <br /> <br />3. FEES <br /> <br />~9'c/. 3777 <br /> <br />Site Evaluation, Single Family Dwelling, lust lot ......................................................................................................... $320.00 <br />Site Evaluation, Single Family Dwelling, ca addl lot ............ ~ ......................................................................................... 235.00 <br /> <br /> Aerobic System .................................................................................................................................. 218.00 <br /> C~sspool ............................................................................................................................................. 382.00 <br /> <br /> Seepag~ Trench .................................................................................................................................. 382.00 <br /> St~p Slope ......................................................................................................................................... 382.00 <br /> <br />Commcralal Plan Review <br /> <br />Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... !30.00 <br />Single Family Dwelling, Major Repair (dr~mfiald) ........................................................................................................ 210.00 <br /> <br /> Receipt: ~'~"'~ <br /> <br />$100/500 gallons <br /> <br />+ $25/500 gallons <br /> <br />+ $25/500 gallons <br /> <br />Date: <br /> <br />Test Holes Ready: <br /> DaR: <br />Tank Pumped: <br /> <br />Pumping Certification Attached: <br /> <br /> <br />