|
r,E. ...„M,
<br /> ,f.,
<br /> ,.
<br /> Wastewater„a, ',,o reatine.0,.nt yst . .
<br /> D 'I
<br /> - 9
<br /> x': h1AItII3Ns�out+�'rY rr�-BL1c VvR floJG 0 4 Z23
<br /> .-'51a -SitvertntiReitmi,' MARION COUNTY
<br /> Selena Va s` 'BUILDING INSPECTION
<br /> -
<br /> .. (503},5S8- I47'.: F i (a03 , #794....
<br /> w;5vw t.miarion: dP'1or:us ctiiitlii Its c t is
<br /> ''/ L!sv b r Fe@AI _ __. _ . ,� „_ �w�._. ...�........ '' .
<br /> •
<br /> tt - fl': er
<br /> it thng.1.44ig
<br /> .,
<br /> Wit~: ` • 4 ri 6 t. �...
<br /> it s Stat4 and 4 . _ . ,cot I�hane _ , .. `... __
<br /> kisct tc x sea T , � t C sa .._
<br /> of ;. Wit'
<br /> ':'rope Address sty St to: :.Zip.0 .
<br />', 5partiel:4_' • T'ax.Lat Acreag.. ..
<br /> :Directi s to Prop s#' ...,
<br /> j' .fY.. z £' k �t ny,j.. """"'^':•'..,., h 3: f�„ L s 4` 4a..;W;1. -`,Xis/.+tY
<br /> ine:�r ��� � { �i►{�+R^yWs.uwK ..... f ,:Y'kkv �' :{'a�.'. S._.::Y^ .-.,..
<br /> .E istutg 4044ifiti*E Prop$cd R dettamt 'Mini ng Commerciat?; i'ropreE t i niatereiatd Water Sitlip
<br /> Pi pile` Y. i°tea '.
<br /> umL cr of Einpl +xsd' Number.ofEtngigyv
<br /> Lkanic
<br /> usttberctti3ednaotnstttuiarrtfl3cxtrc�cuns' ❑ "• .
<br /> Well Spnn&;Shared:
<br /> sI.,• t s "` -s -,--4 -rea`s.q c. -.,..i: , : r 7z. r 9'r".^E� �--t4�'Y "his.-, 'a -,. t- - t'k y f yr
<br /> �� wAi"^<{�#A,ll�;,'� �iw � �'7�- �&{a';,R .�.�, rr�y'a„i�,�s- '�'aiv& ....�� " � �a•.-.;a.•�x2:XazA '' �.-.:.a',�2' .x,..�`�`k
<br /> .❑ to valitattQti' ❑ Renewal Pei ait' ttthonr►titta into a fot
<br /> ❑ Constrnciton Perin t 0 l c.rr lii l0izstat lent. ❑ � alaeifg a Dwelling
<br /> ❑J R atrPertnit 0 PertititT'ransfrr ❑ The t dditiiiri of'One NrOi Bcdrooitis:
<br /> (�, fajor '❑ 1Yftriut ❑ E�tt itag Sys etri Euailttattgtt:: ❑. 'Pers:mal Hardship
<br /> Alienation Pei nit ❑ Ret ordRev ew; 'fete o., Eiotisin
<br /> Giaior C] Miner ❑ (Miter ❑`..Connectin to an Existang 5'ystetu bier am...
<br /> ui tJs
<br /> ..J F
<br /> (ovt:r 5-yrs old)
<br /> ❑,-(ali!er :Please Spei.tfy'
<br /> z-_. ;
<br />' I, 7*.re tired f`etand'attcr rnzekts'urr tot`tt lu d walt;itae pi caf in ii wile 6-ittrn0diri,,voirars,tuc i`ie:
<br /> Pestthe tnnf,tt:a atxi it,the'entrattce to the property Elan-the te;,t-holes%
<br /> By my signature;I crtlfy:thai.ttse informatioii I)have iiir ishcd it o s rrest;_and hereby grant sAiiittir County;.autltttr ze`s!agent ofT e
<br /> .
<br /> Deparfttietit of Eu mental Qaaltty;ps mi scion to enter onto alai a60extescrtfat.i property tot the soipurpasc:it this appt eatton.:,
<br /> L
<br /> Applicant'sWam Plea a Pr4Lgt rly" Applicant's J tii,t ?(wnht r DEQ Lic #(tfapplicablel
<br /> r
<br /> App t'.Mutt Addles tna
<br /> ... . kli 1-t)' 7S'
<br /> ;Si .. F13n er Data (.0 •'t.i,f pl%eablc')
<br /> Apph AS" t_t.O :6'ludiorizedR sentatave:(forni?attaolied). . .
<br /> & tlti:i}.NPIS P 1"1Qt rOINSSS0171.c$.0 dNS1 't::APP JUt.Y4211 Y623bi7E.'C'i s L15:3115 Ci1g,.
<br />
|