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, . <br /> 643- r3S <br /> -, .. .., <br /> Application for''Oogite . <br /> . r.,:c..4.UteiConlyt <br /> ClEC737E <br /> Wastewater , city6f . . <br /> ", ------f,--- -z,:-.s, , Treatment,System • • <br /> ,,. • . DaleRecohed. . <br /> 1WARItigtOVNTY KWIC WORICS: <br /> ..... .... . ..., .._._ Received by <br /> : ee. .,,,, , , . Ru 1 LD NG <br /> .. SI EP 0 6 2023 <br /> tturbiN.O.IN5ncT.I.Qpi.!00ilsitiN , Zoniewtil', <br /> $'1'55 WertenftriA - MARION couNiy <br /> '00wst4.014i16' INSPECTION <br /> ($04)5811.;•5147- tax::(8164$08';7948; .Iteee04, .. . <br /> .-Aettoityt <br /> www:to:thiviiiiit:iitaisTPW.Itiiiidingins4iettion. :. • : , - ' . <br /> . . .. <br />. '"-St "1/4jk, ,i..,,. klA,L.. W,'. I ql:C(fri., -:S Q.-:It'9:04, i‘A.:YlIvr.),SA:,....•N,e,..1-•,,A\): , •,•Y.,:.o-I,--a _OR 19710.() <br /> Nam , . . . . ...... . <br /> . .. .._ <br /> Name 01411Int.Acklf0§§;. tit.):,;Stitei*Ut VP (Ai*4'!.004:0ITli010. . <br /> • ' '-'"'" • . it*Ptdpun: • ti.iiiri. .. <br /> 01-1"t WIS 'a.: - -60 ' ' *--CS'--T" - — ' '' tra -tkoe--,-e 3- • " <br /> . ...... . . ..... . . . . „ <br /> LetApoo,otiop Tak Lot Acrea.g.02•Pai0*.O. <br /> .„ . . <br /> . . .. . .. . . . . ., . . .. <br /> Subdivision Name :Lot tinek. <br /> ..< <br /> talavto <br /> '... . ENNNee -0- : <br /> e <br /> r.o: s. <br /> tk bK'__•••-• <br /> Property Address City State Zq C.-•o.1•:,d•0•:.•.e•..0• ...-.,•.0. <br /> .... <br /> , <br /> Oirectionste.PropektP... <br /> „. .. . .... _ <br /> .... . . ... . ...._ . . . .. .. <br /> ''::0A1.51:5#11-0.#1atiliVtt.40.k04700.*t...W44106:140Atitiit?.' : 47,',: mi:::zg:::4XgA:: 3,,•-.5,: ,•.,..:.: -,, <br /> Existing Facility Proposed Facility. Watersqpir <br /> VIIII Single Family Residence 0 Single Family Residence - Drub& <br /> .. . <br /> -,g6t$2a#A `Name <br /> .. . .. . <br /> Nnintler.efRedranni& ,Netaber'efRedteema ' • • 14=vide- .: . ... .. .. <br /> JOther I—d--tthtt ,,•••e. c . . .S pri... <br /> n g <br /> Shared <br /> 13:z:,Type:,44PIKOAks.::::L .":;i:,4;.: ':'1:::• :- ;::'::::::;.`fkE:E.,q,,j;',Z-1,4-tTi,,,.:::1,F_;; ;;•:;„1', .., :- ;7:7. 1;- <br /> RSite Evaluation Et Renewal Permit DA0b9rk400,:No*e:.for: <br /> Construction:Perinit Et Pernik Reinstatement Cf:RepleOng.::*tivielling <br /> [=: Repair Permit .C1!licmitT0000 El The.Addition of.0ne.i:tir Mijt0!49mns <br /> . 0:Major ::::1:Minor 0,104:tiiig System Evaluation '0:-Personalnardghity <br /> [:1 Alteration Permit 0: Record Review ET temporary,fiensing <br /> 0 Mafor. :...E:1: Minor 1:3:',Other ., ID: Criiiiientingte..ait Eiiating'S'Yatentlieyerht Vae: <br /> (i:59*4-lraibit4 <br /> El Oitot,-Please,C.gpWii), <br /> • - - .. ., . - - ...„ . - ----- „ , . <br /> If ti2.0.iv.4yifettfig'ilnd:attdchmentidro ktoriiidro40dioith:thimilioatiOri:,..ft*ig beitturnedtaygrf4 incompletei <br /> Post the:otabge.cara::a(the-„entraii0kftfth0:00:Periy,Flag the test lidien: <br /> %ifiSiiiganterei,1 certify that the infurmation I have furrushed is 0404 i#4,hdrariwaiit#Iaft0(00#34,4;ithorfzeit apt:it:Of-0# .. <br /> Department ottrivironmprot.Q**y,permission to enter onto the above privertifer't*aein purposenf-diiaaptgieathin <br /> .,.i. <br /> , . . ... ... : - .. •- ' ' .' ' <br /> rbr.,611 Ltrosal 6,-b&S.39'--1.:(00c) . agsq- ta <br /> . .1..: .a.. s, .tyl..oxittAic , . .. .. q , .6 <br /> Applicant's.Nariie,--10se Print Legibly - Aiii*.ilitO-Phone:litunia "- .15ER:Lic #.(if:aPii114010 <br /> ,... . . .. <br /> ... : „ . . .. . OR - -1,-. •,. ,-:. ... .„. „ . . .. . <br /> Appuaries:maiiiiiim41:0§! - - -- -- - <br /> {'-&-- exod):A:44ini4 •-•--. .. „ 9t 1 t.0.1.ai--. <br /> sott, :.(j:-. : .: Date::' CCW# ( -PPlicablq. <br /> .. <br /> Applieapt.#ttie:'-.1abviner -.Authorized.Repre5entanye , , A.intl. drizatibit.to:A,pply- .lorm Atte- ehed <br />