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Envi~nmental ~lth ~.rvie~s DivZiffl~,-'. <br />MariOn 00unty Depavtm~ Of Public Health <br />S~Iem, ¢k~con 9730~ (588-53!8), aCent far: <br /> <br />.cb be submitted with applicatio~ for <br />tm,~lclin~ permit o~ ra~bile bcm~ place- <br /> <br />Application to ~Jae I~t of Envlro~ental Quality <br />for a Permit to Consi-ruct a New ~r ~ <br />a Subsurface S--~~os~l SFstem <br /> <br />Permit Fees: New - $50.00 ($R~5.00 ~ith site ev~lu¢%ice) <br /> <br />Repair, Alter~tio~ <br /> <br />T 3 R <br /> <br />Tax Dot or Accoun~ # <br /> <br />160 ac~s <br /> <br />Rt. 2, BoX 79~ Aurora <br /> <br />1W <br /> <br />installer' a Name <br /> <br />New Constm/ction <br /> <br />x ~e~r <br /> <br />Insta/lation will serve: I{om~a <br /> <br />__ Nobile N~me __ MObile ~ Park <br /> <br />C~,,~rcial Building <br /> <br />__ Othe~ (expls-ill) Restroom to serve nursery emplovees <br /> <br />N~ber of Livio¢ Units <br /> <br />...... Nt~aberof~ 2 toilets <br /> <br />Wate~ S~pply: Public ........... (l~m~itT__ l~ivate__ <br /> <br />C,~Dispo~al? <br /> <br />1. ~ ~ub~rface ~vage Dt~ 8yst~ra Plot Plan <br /> <br />I h~reby certify that the i~form~tio~ core,aimed in t .hi~, application is t~ <br />~ ~ ~ o~ ~ ~ ~ ~i~. ~ ,; ~" /~. ~ ~', <br /> <br />~-s7 7/74 D~%e ............. <br /> <br /> <br />