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SI'ATE OF OBEGON <br />DEPARTMEN~ O1~' E~fi[I~OIqIM~Iq'I'AL QUALFI'Y <br /> <br />REPORT OF EVALUATION FOR ONE LOT <br /> ON4~rE ~WA~E <br /> <br />The Entire Property ~Has <br /> [] Has No~ l~t~n Evaluated <br />PLOT PLA~ OF APPROVABLE ~..EAz <br /> <br />Any alteration of tl~ natural conditiol~ in ~ ~a a <br />approval <br />~is ap~val ~ glen ~ the basis ~t ~e ~ ~ ~l ~i~ a~ve will n~ ~ f~er ~it~ ~ so~i~d~ a~ <br />that ~nditio~ on sub~ or ~a~nt ~ies ~ not ~n al~d in a~ ~r w~ would ~ibit l~u~ of a <br />~it ia a~ ~ O.~S. ~.~5 ~h 4~,7~ and ~n~a~ve Rules of ~e En~nmen~l Q~lity <br />Con. ion. A~ s~ su~iv~on, pa~tio~ng or al~ra~lon ~ void ~S <br /> <br />The si~ ~ ~ fou~ sui~ble f~ i~l~o~ of ~e followi~ kin& of <br />limi~o~ and .~ditio~l ~ui~e~ i~i~: <br /> <br /> ...... <br /> <br />WAHNING: This document is a t~chrficai report for on-~it~ sewage disposal only. It may be conv~rt~l to a permit only <br /> if, at the time o~ application, the parcel h~ been found to be comp~tlble with applicable LCDC- <br /> ~cknowled$~l I~.al comprehensive land u~e plans ~,~! implementing rneaau~es or the Sta~ide Plarming <br /> Goals. The Statement of Coml~Ibility may be made ~m the attached forrn or its equivalent. Authorized <br /> Agent appt~oval is req~irt~d beforc& consl~q;iorl p0rmit c~ ~ issued_ <br />Th.,'~s rel~ort is. v~l ur~il ~r~ o~-~it~ sewag~ symptom i~ installed pursuant to a ~onstructlon permit olXained from <br />-~ - ~ - , or until e~....!ier ~mcallatlon, pursuant to Commi~ion rulea, with written notlc~ <br />thereof by the Detmrtman/./of E~{vh~m{mental Quality to the ownerS accordillg to Department records or ~ County tax <br /> <br /> <br />