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NAME: <br /> <br />ADPZES S: <br /> <br />aTE: <br /> <br />SECTION: ~%LTOWNSHIP:j~Z~__~ANGE:J~>_ <br />TAX nOT NO: <br /> <br />SITE EVALUATION <br />FILE NO: <br /> <br />'[iL__ _--:~:~:'?:'iii' <br /> <br />#1 #2 #3 #4 <br /> <br />SOIL <br />NO t t ].ing: <br />Eff. Soil <br />.... Depth <br /> <br />SYSTEM MUST BE INSTALLED AS SHOWN: <br /> <br />SYSTEM DESIGN <br /> <br />Daily Sewage Flow: <br />Tank: ~ C~g3_t~O <br /> <br />Distribution: ~~__l__ <br />Type of System:~DqA~D~ <br /> <br />Trench <br />Rock Depth: <br /> <br />Minimum Backfill: <br /> <br />Test Holes: 0 = Acceptable; ~ = Not Accept <br /> <br />'i%is document is a technical report for on-site sewage disposal only, It may be converted <br />to a permit only if, at the time of application, the parcel has been found to be compatible <br />with applicable LCDC~acknowledged local comprenhensive land use plans and implementing <br />measures or the Statewlde Planning Goals. Authorized Agent approval is r/~red b~fore <br />a construction permit can be issued. //Z ~ <br /> <br />The proposed site of the sewage system installation has been reviewed and approved by the <br />Marion County Sanitarian. <br /> <br /> PERMIT NO: <br /> DATE: S~%NITARIAN: <br /> <br />T~is permit expires one year from date. <br /> <br />ERF/cer <br /> <br /> <br />