Laserfiche WebLink
To be aubm~ed with eppliea~on for <br />b~l~r~ permit or ~obtle homm place- <br /> <br />Applic&tion to the Department of ~vi~omme~tal Quality <br />for a Permit to'.Cg~S~ct a New ot'l~palT <br />a Subsurface Se~a~e Die~oaal System <br /> <br />~ar~t Peas: N__~- $75.00 ($37.50 wl;h aite evaluation) <br /> <br /> INFORMATION <br /> <br /> H. & Thclma F. Bu~ett <br /> <br /> 10664 Silver Falls ~. 5t <br /> <br /> :.umavill~ Or 97325 <br /> <br />stiJ, Code ..... <br /> <br />Tax ~o= or Accoun~ ~ <br /> <br />-__ <br /> p~It~ Add,ess <br /> <br />New Cou~tr~tion . . <br /> <br />Installation will ae~e: <br /> <br />Coa~ercial Buildin~. <br /> <br />m <br /> <br /> ~ 'hack <br />Repair ........ <br /> <br />..... Mobile Home' Mobile Home Park <br /> <br />Other (explain) <br /> <br />Number of <br /> <br />~aZer Supply= Publtc.___CommUmtty ,, <br /> <br /> 3 <br /> Number Of Bedroo~ . <br /> <br />.. Private~x Garbage Dispoeal? ~(~"~ <br /> <br />1. Proposed Subsurface Sewage Disposal System <br /> <br />2. Pl&uniug ~valuatto~ ~ Bt~lldi~g Permt~ <br /> <br />3. Butldin~ Plans <br /> <br /> hereby certify that the info~tion contained tm this application is true and correct <br />to the best of'my koo~l~dge mid belief. <br /> <br />Perm/t No. <br />Issued <br /> <br />rev. 12/76 <br /> <br /> <br />