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· FOR CITY IIs~ ONLY I MARION COUNTY BUILDING INSPECTION <br />~ [ 'x a ~ · [ff , I COMMUNITy DEVELOPMENT CENTER <br /> <br /> Zoning Vali~da?~on: fc...-.-] ] 8:0Oam-4:30pm Phone 588-5147 <br /> ~ - . 24 hr. Inspection Line 588-7904 <br /> l~aT¢. ~ y~ / FAX Sg8-794~ <br /> <br /> SITE EVALUATION AND/OR SEPTIC PERMIT APPLICATION <br /> 1. LOCATION OF INSTALLATION <br /> <br /> CuU~T¥ <br />FIUILDING INSPECTIO~ <br /> <br />Subdivision Lot Block No. Employees ~ <br /> <br />2. CONTRACTOR INFORMATION <br /> <br /> " <br /> <br /> 6~ gallons - 10~ ~lons ............................................................................................................... lJJ.O0 <br /> P~p or ~s~ Siph~ ....................................................................................................................... 25.00 <br /> <br />$ <br /> <br />+ $100/500 gallons <br /> <br />+ $25/500 gallons <br />+ $25/500 gallons <br /> <br /> Septic Reinspection Fee ............................................. . .......................................................... 25.00 <br /> Septic Inspection for which no fee is specifically indicated .............................................................................................. ~00_/~r. <br /> <br />SignatureofApplic~' D.,~ d~ Date: <br />MC 15-S1 Rev 8/95 Pumping Certification Attached: (Y) (N) <br /> <br /> <br />