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Depar~ent of Enviromnen~al Quality M~/~ION cO~ DZ~ARTME~r O~ P~aUC N~&Ta La~4 Quality <br />1234 S, W. Morri~on SA~ OR~ON ~l · 5~ COunty <br />Portland, Oregon 97205 ...... <br /> <br />Application tO the Depax~ment of P. nvtx~nmental ~uallty <br /> <br /> New or ReDair a subsurface Sfneage <br /> <br /> D~OSal Syst~ <br /> Permit Fees: New~ ; ~ir,...Alter~t~0n $15-00 <br /> $~0.00 ($2E.00 with s~te ev~l~a~,ion) <br /> <br />REFERENCE INFORMATION <br /> <br /> ., ~ ~ize ........ <br /> <br />DESCRIPTION <br /> <br />New Construction ,~ ..... I~.el~,,~ <br /> <br />Mobile Home Park <br /> <br />Commercial Building______other (E~platn) ........... <br /> <br />No. of Living Units No. B~s 3 <br />Water Supply~ Public ~ity ....... P~iva~e ~ Garbage Di~po~al? <br /> <br />REQUIRZD EXHIBITS <br /> <br />1- Proposed subsurface Sewage Disposal Syste~{ <br /> <br />Plan <br /> <br />Planning Evaluation - Building Permit (Local <br /> <br />Other (Local option) ~g Flans <br /> <br /> <br />