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Ma=iOn Co~ty ~alth ~p~ent ~n-refund~le ~.00 <br />Sal~, Oregon 97301 p~ 16t to ~ ~tted <br />Phone: 58~5346 wi~ <br /> <br />rec. ~1902 <br /> <br /> DESCriPTION ~ ~ARCEL (Attach P10t Pla~ as Exhibit A) <br /> S~ction~,-~ TownshipL; Range ~ ~3 ~ty of M~on, ,Oregon, T~ lot <br /> <br />PRKSENTLY D~ISNATSD L~D USE) ~NZNG, ~D N~ OF'D~I~ATiNG <br /> <br />Show loca~on of proposed s~s~ace sewa system or $Ys~s on t~ plo~ plan <br />which is a~tac~d as ~hibit A. <br />NW~ The =iOn Co~y ~alth ~p~en~) 8s con.act agent for ~he D.E.Q., must <br />comple~ a site Inves~ga~on ~fore a stat~ent can ~ :given. In o=der ~ verify <br />soil t~es ~d dete~lne t~s sutt~llity~ it is Often necess~y t0 ~equire two (2) <br />soil test ~!es 2 ft. by 3 '~, wide and 4 ft. deep ~d 75 f~. ap~t in the <br />proposed ~or ~e sewage sys~. ~ou will be contacted if field ~ve~ation <br />in~ca~s a need for ~uch ~ies. ~es~ hoses ~* required for ~re ~an one p~cet. <br />T~s re~rt, W~n c~pleted~ will ~t el~ina~e ~* need for meq~red planning <br />co.lesion approval, building oz l~a~on <br /> Test ~les ( } have been p~ep~ed ( ) will b~ prepped by <br /> <br /> I H~R~Y R~QUEST FROM T~ D~ARTM~NT OF ENV~ON~NTAL QU~Z~ A STATE~NT OF ~PROV~ <br /> OF T~ ~VE ~T~D <br /> please print <br /> <br /> ~dresa of Applic~t <br /> City, State, Zip Code ~.~c. ~Tq~. Date _~~ ....... <br /> <br /> (for D~ or Agent use only) <br /> <br /> ~ents and re~endatious ~ased on Subs~face Si~ InvestigatiO~% by D~ or Con.act <br /> <br />The soils ~e s~l~ to Salk~ s$~y ¢~ay lo~. S'~ong $~ed silty C~ay at 2¢". <br />Approved for o~ ~esite on lo a~es pe~ng accept~le plot plans priar ~ any con- <br />s~uction. ~he sewage <br />the shallow soil dep~ at <br /> <br /> <br />