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EnVirowaental Qualit7 Division <br />Evalua=ion of Property <br />Subsurface Sewage Disposal <br /> <br />able, $~7.50 per lot. to <br />be submitted with appli- <br />cation. <br /> <br /> 120 ~Ligh Street 1~ <br /> Salem~ 0regou 97301 <br /> Phone No: 588-5167 <br /> <br />~CEL SlZS: Acres ~ ~ .... N~ber of ~ts / ., ,,, <br />~RO~OS~9 US~ OF ~ARCEL~ (X) ~sideneial/Reereatio~l ~q.~ ~.~,~ ~~ <br /> <br />( ) ~estautant ..... ($eatiu~ ~apacity} <br /> <br />( ) Other <br /> <br />T~ST HOLE REQUIR~I~NTS~ <br /> <br /> One Homesi:e: <br /> <br /> ~0 or moYe <br /> <br />You will no~ seed to dig test holes unles~ soil conditions prohibit use of <br />ocr ay[ers (such as reeky S:ound). <br /> <br />~o test hol~s mu~t be prepared on each parcel. 2' x 3' wide and 4' de~p. <br />and 7~* apa~ in the p~oposed areas. <br /> <br />TEST MOLES: ( ) Have been prepared. <br /> ( ) Will be prepared by. .... ,,, ,,,(Dare), <br /> <br /> (21ease print or <br /> <br />TITLE (check one): ( ) O~ne (~) Buyer <br /> <br />OR AUTHORI2RD AG~ ~ ~ ~ <br />if other than appltcan:, for pe~ast0R eue upon ~r~er~, <br /> <br />The plot plan form ou the back.st be completed. ~ease follow directions care~ <br /> <br /> <br />