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'R~T~N TO: <br />Harion County Henl=h Department <br />3180 Center S=, NE, Room 220 <br />~alem. Oregon 97301 <br /> <br />DKSCRIPTION OF PARCEL (At~a=h Plot Pla~ as Exhibit A) <br /> Section f~ ; Township ~f ; Range /~/ ; ~o~lty of ~?~2_~, Oregon; Tax lot ~ <br /> <br /> if for a co~rcial b~ ne~ or restau~an:, we ~eed to kn~ ~h~ ~er o~ employee~ ~d/ <br /> or the seating <br /> P~S~Y DESI~ ~ OF DESI~ATING AG~CY: ' <br /> <br />~ST t{0L~ ~qo . '- <br />~.~o~sft~= You will not need ~o dig test holes ~l~ss notified. <br />~o or More Hom~st~e~: ~o ~est holes ~s= be prepared on each parcel, 2 ft. by 3 ft. wide <br /> and 4 ft. deep, aod 75 ft. apart in the proposed areas. <br /> <br />~M~S ~PORT IS NO~~ PER~- I~ does no~ eli~nat~ ~e need for required plannin~ c~- <br />sion approval, building, or location permits. <br /> <br />I HEREBy ~ZQb~ST FROM THE DEPARTMENT OF ENVIRO~MP2Ff~ QUALITY A STATEMENT OF FEASIBILITY OF <br />THE ABOVE M~THOD OF SEWAGE DISPO~/~ ~OR T~E ABOVE DESCRIBED PARCEL. <br /> ,__~~__~ Signature of Appliean~f(~/-- ~-- iy~ ~.~j__-- <br />Nam~ <br /> of <br /> <br />A~,'.~ss of AppZlc:n~~{{~ ~'~' 7[~ ~2[6~ Title Owner, Buyer... ~A ent~ <br /> <br />**********************************************************************************--. <br /> (for DEQ or Agent uS* only) <br /> <br />Statmoor of D~Q/Contwacg ~eu~ ~lative to ~ove Application <br /> <br /> <br />