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Enviromuen. tal Health Services Division <br />U~rion County D~oartm~mt of Public Health <br />Gal~m, C~egon 97301 (558-~346), agent for: <br />J~partr,~,;nt of ~:viroumsntal Quality <br /> <br />Tb be ~ubmitted with application for <br />building permit or nobile home place- <br />meat permit. <br /> <br />Application to the Department of Environmental Quality <br />for a PelTsit to~C°nstract a New or Repair <br />a Subsurface Sewage Disposal System <br /> <br />Permit Fees: <br /> <br />Ne%v - $50.00 ($25.00 with site evaluation) <br />Rel~.air ~ Alteraticm - $15.00 <br /> <br />Edward Shannon <br /> <br />Nm.~ of Applicant <br /> <br />Section <br /> <br /> Rt. 2 Box 190 <br />Mailin~ Address <br /> <br />City, State, Zip Code <br /> <br />Tax Lot or Account # <br />Lot Siz~e 101 acres <br /> <br /> Rt. 2 BOX 190 Aurora <br /> <br />Prop~ty Address <br />Installer's Nmme <br /> <br />B. C~NEPJ~ DESCRIPTION <br /> <br />New Construction <br /> <br />Installation will serve: <br /> <br />Commercial Building <br /> <br />Number of Living Units <br /> <br />Water Supply: Public <br /> <br /> Repair <br /> <br /> House ~obile Hc~ne <br />__Other (explain) <br /> <br /> , ~,,,,,, Mebile }lc{ne Park <br /> <br /> / Number of Bedrocms / <br />__ Cc~mmi~y __ Private X, Garbnge Disposal? <br /> <br />C. ~UIRED .EXHIBITS <br /> <br />1. t'~opesed Subsurface Stye Disposal System Plot Plan <br />2. Planning Evaltm.tion -- BuildingPermit <br /> <br />3. ~Lilding Plans <br /> <br />I hereby certify that the information contained in this application is true and correct <br /> <br />to the best of ray knowledge and belief. <br />I,~I-57 7/74 <br /> <br /> <br />