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To be submlt~ed wi2h appl{ca~ion for <br />building pe~it or mobile home place- <br />ment perm/~. <br /> <br />for a Pe~t ~o'Cou~Uc__~a New o~'Ri~air <br />a Subsurface S~ge D~al System <br /> <br />Permi~ Peea: ~ew - $75.00 ($37.50 with rite evaluae~on) <br /> <br />Repair, Replao~ Alteration- $25.00 <br /> <br />I{EFEI{ENC~ INFOR~_.TION <br />N~me of Applic~ut <br /> <br />8U61 Little Road <br /> <br />Section <br /> <br />Aumav~ ] ] .. O~e~on q75P~5 <br /> <br />si=e V iua io ze=ial Mumher <br /> <br />Tax Lot or Aecoun~ # <br /> <br />Lo~ $!~e , 19.5 <br /> <br />Pt:oper ty Address <br /> <br />B. CENE~ DESCRIPTION <br /> <br />Installer'~ Name <br /> <br />Number of Living Umils <br /> <br />Wz~er Supply~ Public <br /> <br />~F. EqOIR~B EXhiBITS <br /> <br />Repair ~?]nme .... <br /> <br />Hou~e~X :Mobile Home' <br /> <br />Hoblle Home Park <br /> <br />Ouher (explain) <br /> <br /> __NUmber of Bedrooms ~ <br /> <br />--. Commo.nity ,. Private X Garbage DisPosal? no <br /> <br />1. Proposed Subsurface Sewage Disposal System Plot Plan <br /> <br />2, Plarvaing Evaluation -- Building Pex~Lit <br /> <br />3. Bulldlmg Plans <br /> <br />I hereby certif? that the tnforma~ion Contained in this application ia true and correct <br />~o the best of'my kr~)wledge and belief. <br /> <br />~$7 rev. 12/76 <br /> <br /> 30. 1978 <br />Date <br /> <br /> <br />