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STATE OF OREGON DEPARTMENT OF ENVIRONMENTAl. QUALITY REPORT OF EVALUATION FOR ONE LOT ON-SITE $1~WAGE SYSTEMS The Entire Property [~fHas [] Has Not Been Evaluated For Office Use Only 9-, gG_ ,~ ....... PLOT PLAN OF APPROVABLE AREA: Any alteration of the natural conditions in the a~a approved for the ~tem or repla~ment area may voi~s approval. This approval is given on the basis that the lot or parcel described a~ve will not ~ fur~er pa~itionsd or ~u~vided and that conditio~ on subject or adjacent pretties have not ~en alfred in any manner which would prohibit issuan~ of a ~it in ac~rdance with O.R.S, 454,~5 through 454,755 and Adminls~rative Rules of the Environmental ~uali~y Commission. Any such su~ivision, positioning or al~ration may void this repo~. The site has been found suitable for installation of the following kinds of on-site sewage disposal systems, with the WARNING: This document is a technical report for on-site sewage disposal only, It may be converted tea permit only if, at thc time of application, the parcel hzs been found to be COmpatible with applicable LCDC- acknowledged local comprehensive land use plans and implementing measures or the Storewide Planning Goals, The Stateraent of Compatibility may be made on the attached form or its equivalent. Authorized Agent approval is required before a construction permit can be issued. T~s repprt i~ v~4~ u~il~y~-~te ~ewage system is inetalled pursuant to a construction permit obtained from _.~w ~/~,~.~q~:.j]~F. ff~ffor until earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department/of Erlvirenmental Quality to the owners according to Department records or the County tax rec°rds' 7_J.~~is rep~°rt runs with the land and will aut°matically bensfit subsequent °wners']]~.~ //- ~]'(~ ~2~v~ ~