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Environments/ Health S~vice$ Division <br />l~rio~ County Department of Public Health <br />S~l~n~ t~re~on 9730/ (598-~), agorot for: <br />Dep~z~nt of ~nvir~mm~t~l ~ity <br /> <br />TO be submitted with ~pplication for <br />bttildir~ p~rmit or mobile hc~e place- <br />ment perm~ t. <br /> <br />T L/ R /L~._,) <br /> <br />Tax Lot or Acco~ ~ <br /> <br />B. GENE~bL DESCRIPTIC~ <br /> <br />~krasu ...... ~,k~bile Ht~e -- }(obile Hc~e ~ark <br /> <br />Other (explain) <br /> / <br /> Number of ~droc~$ __ . <br /> <br /> Cc~mmi~y ,, Private ~Garbage Disposing? ........... <br /> <br />1. Propos~ Subsurface $~ge Disposal SS~tem Plot Plan <br /> <br />2. Planning EvmluatiOn -- ~,ildir~ Pex~it <br /> <br />3, ~uild/ng Plans <br /> <br /> <br />