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rec. no. 5255 <br /> <br />RETURN <br />Marion County Meal%h <br />Salem~ Oregoa 97301 <br />Phon~; 588-5346 <br /> <br />FEE ~CNUDULE: <br />Non-refundable $25.00 <br />per lot to be submitted <br />with a~p lica~ion. <br /> <br /> ~ec~ion~.~2~; Township ~_; Range ~ C~unty of ~ , 0re~n, T~ lot . <br /> N~rative ~ription: <br /> ...... ..... - ,, ' <br /> <br />P~ES~TLY ~,~'h!~NAT~D ~ND U~,~NING~ ~' N~ OF DESZGNATI~ AG~ <br /> <br />att~hed as ~hibit A. <br />NO~: The M~lon ~ty ~alth ~p~t~ ~ ~n~act agent for t~ <br /> <br /> soil test ~le~ 5 ft. deep and 75 ft, ap~t in ~e ~em p~sed ~Or ~ $~wage <br /> <br />c~pl~d~ will ~t el~nate ~ n~ f~ ~r~ pl~ng ~is$iOn approvaI~ <br /> <br /> T. st ~les (~) have ~em prep~ed ( ) will ~ pr.p~ed b~ <br /> (date) <br /> <br />I ~RP. BY REQUEST FROM THE D~ARTMENT OF ENVIRONMENTAL QUALiTY A STATEMENT OF AggROVAL <br />OF TH~ ABOVE M~THOD OF SEWAGE DI-~OSAL FOR ~ A~OVE DESCRIBED PARCF2Lo <br /> <br /> ~eas~ print <br /> <br />Address of Applicant ~.~ F <br />City, State, Zip Code/~~.~ <br /> <br />of Applicant <br /> <br /> Title <br /> <br /> (for DEQ Or Age~tuse only) <br /> <br />Comments and recommendations ba-~ed on ~%tbaurface Site Inves~igation by DEQ or contract <br />Agent: <br /> <br />Soil is similar ~o Nekia si1%y clot loam on the higher par~ of the proper~y and <br />unacceptable W~o <br />for o~ ~site ~o~d~ th~ <br />pa~ of the ~o~y <br />from the c~nty <br /> <br />St~atement of DE~ ~elativ~ to Above A~pLication <br /> <br /> <br />