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Environmental }~a/th Services Division <br />~ion County Depa~am~nt of ~blic Eealth <br />$¢l~u, Oregon 97301 (588~5~46), a~ent fo~: <br /> <br />-mo be su~dttod wi~h apD~ication for <br />buildir~ pe~uit or mobile berne <br /> <br />Application to the rk%oa~-~.~ut of Envirorm~nt~l Quality <br />for a Perm/t to Coz~truc~ a Now or ~ <br />~ ~urface ~e ~.~x~l Systeu <br /> <br />l~m~t Fea~: N__~i - $60.00 ($25.00 wi~h site evaluation) <br /> <br /> Charles Chappelle <br /> ~e of Applicant ~ <br /> <br /> ~ 3375 48th Ave NE <br />~ii~" 'AC~s~ ....... <br /> <br /> Salem <br /> <br />Section l& T 8 R 2w <br /> <br />Tax Lot or Account # <br /> <br />Lot Size 1 acre <br /> <br /> 8376 Redwood Dr, SE~ Aumsville <br />Property AddreSS <br /> <br />New Construction x <br /> <br />Installation will se~ve: ~k~se <br />Oam~ercial Bttildin~ ~ <br /> <br />Number of Ltvin~ Units <br /> <br />~,ater EuPply: Public <br /> <br />R~pair <br /> <br />Mobile <br /> <br />o~h~ (~) <br /> <br />.... Number of B~lrocms <br /> <br />3 <br /> <br />(~ity Private <br /> <br />~.Arba~e Disposal? no <br /> <br />1. r~0~ Subsurface Sawage Disposa/ .Sy~en Plot Plmu <br />2. Planning Evaluation -- Building PeXfait <br /> <br />S. ~.~ildin~ P~u~ <br /> <br /> L~eby certify t."~ the iuformatio~ contained ~ tS~s ~pli~ti~ is t~e ~d ~r~t <br /> tho ~ of <br /> <br />~i~ No. ~ <br /> <br /> <br />