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Department of ~nviZonmen~al ~uality <br />1234 S. W. Morri~on <br />Por~la~, 0~gon 97205 <br /> <br />Application to ~he De~artment of Env~onm~ntal Quality <br /> <br /> for a Pe~uit to .C~. nstruc~t a <br /> <br /> New oF ~e~air a Subsurface $~wage <br /> Disposal Syst~ <br /> <br /> Permit Feas: New $30.00 Repair, Al.ter.atio~ $15000 <br /> <br />A. REFERenCE INF0~J~ATION <br /> <br />8. GENERAL D~CRI~I~ <br /> <br />N~W Construct/on. , <br /> <br />Installation will sezve: <br /> <br />. .. Re, ir ......... <br /> <br /> Mobile I~me.. ~ _M~bile ~e Park <br /> <br />Commercial Building <br />No. of L£ving Units <br /> <br />~her (m~pla~n) <br /> <br />~o. ~earoomS~ <br /> <br />, Co~mnmtty <br /> <br />Privat~ ~Garbage Di ~posal~ _ <br /> <br />1. Pro~ose~ Sub=~rf&ce Sewage Disposal syst~ <br /> <br />Planning ~aluation - B~ilding Per~i2 _(Local O~2~n; .. , <br /> <br />Other (Local Opt/mn) ~uild~ns ~lan_~ , <br /> <br />I hereby c~fy that ~ ~nfot~2~on cont~ined ~n this applica~on is tr~e ~nd <br />correct ~o ~he best of my k~wledge and b~ief. <br /> <br /> D~t~z <br />Inter~ Form #1 <br /> <br /> <br />