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0R CIT-YUSIg~ONLY [ MARION COUNTY BUILDING <br />lReceivedBy: I~D~. 285~ehSt.~- R~ml32 <br />I . . . ~- ~-' I ~ S~em, O~gon97301 <br />[Zomng / 8:00am~:3Opm Phone 58~5147 <br />IDAC' /-~] / ~4 hr. Impecfion Line 5.-7904 <br />I ' -- -- " / F~ ~8-7948 <br /> SITE EVALUATION AND/OR SEPTIC PE~IT <br />1. LOCATION OF ~ST~LATION <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />3. FEES <br /> <br />Commercial Minor Repair ............... . ..... 173 00 <br />Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 <br />Single Family Dwelling, Major Repair (drainfield) ........................................................................................................ 210.00 <br /> <br />+ $100/500 gallons <br /> <br />+ $251500 gallons <br />+ $251500 gallons <br /> <br />Name o f Applicant (p e~_~ Print): f')~LOt (~[ ( /)/~ ~.tr~ <br /> <br /> <br />