Laserfiche WebLink
Enviro~mental Health Services Division <br /> <br />5slem, Oregon 97301 (588-$346), agent for: <br /> <br />Permit ~aa: Ne~- $75.00 ($37.~0 wi~b sit~ ev~luetion) <br /> <br />~epatr, P~ep~ace, Alte~tion - $25.00 <br /> <br /> Joyce Niwkirk <br />Name of Applieam~ <br /> <br /> 17415 Brown <br /> <br />Mailing Address <br /> Dallas 99338 <br />"City, s~--~--~zi~ Code <br /> <br />Tax Lot or Account ~ ~ _ .... <br /> <br />Los <br /> z~576' M~ple S~. <br />P~opezty Address <br /> <br />S:[te Eval~mtien S~rial Number <br /> <br /> Mel Sawy~.~, <br />Inetaller's Name <br /> <br />~NERAL_ DESCRI~TXO~ <br /> <br />New Cous~ruc~iOn ~ <br /> <br />Insta/ls~ion will serve: <br /> <br />Repair .._ <br /> <br />~obtle Home <br /> <br />cheok <br /> <br />Mobile Home P~r~ ,, <br /> <br />Number of Living Units, <br /> <br />Water Supply: Public x <br /> <br /> 1 <br /> <br />Co~munity ...... <br /> <br />N,-~er of Sedroom~ ~ <br /> <br />Proposed Subsurface Sewage Disposal Sy~6m Plot Plan <br /> <br />2, Pla.~in& gvaluatiou ~- Build/ma Permit <br /> <br />3. ~eildin§ Plans <br /> <br />to the best Of ~y knowledge and belief. <br /> <br />~R-57 rev. 12/76 <br /> <br /> <br />