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~rATI~ OF OREGON <br />DEPARTMENT OF ~NV[RON-MEN'TAL QUALITY <br /> <br />REPORT OF EVALUATION FOR ONE LOT · <br /> O1~1~ ~.~WAGE SYMTEMM <br /> <br />The Entire Prel~rty ~I-Ias <br /> ,, [] .~:,~ iq~t Been Evaluated <br /> <br />For Office U~e Only <br /> <br />PLOT PLAN OF APPROVABLE AREAl <br /> <br />i: <br /> <br />Any alteration of the matura] conditions in the area approved for the on-site system or replacement ar~ may <br /> <br />approval, <br />This at~preval is given on the basis that the lot or parcel dezcribed above will not bo further partitioned or subdivided and <br />thai co~ditien$ on subject or adjacent properties have net been altered in any manner which would prohibit issuance of a <br />l~ernlit in accordance with O.R.S. 454,60~i through 454.75~ and Administrative Rules of the Environmental Quality <br />Commission. Any ~uch subdivision, partitioning or alteration may void this report_ <br /> <br />The site has been found $uitable for installation of the following kinds of 0n-zite sewage dispeaal syztom~, with the <br />]i~~ndicated: .... <br /> <br />WARNING: This docuroent is a technical report for on-site ~ewage disposal only. It may be converted to a permit only <br /> if, at the ~rne of application, the parcel has been found to be compatible with applicable LGDC- <br /> acknowledged local comprehensive land u~e plans and implementing rneasure~ or the Statewide Planning <br /> Goals. The Statement of Compatibility may be made on the attached form or its equivalent. Authorized <br /> Agent approval is required before a consti~ction permil; can be issued. <br /> <br /> -o~ ~. ,~-~, ~_~_~r. ; or until earlier car~ellation, pursuant to Commx~xon rnle~, with written notice <br />;hereo~kb.y the Depaj~me~ ,tlof EnVironmental Quality to the owners according to Department records or the County tax <br /> <br /> <br />