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Sale'", O~el~, 97301 (~88-5346)~ n~emt for: <br />l~pn~m~t of ~av~rom~*~tal (~um1~ty <br /> <br />%0 'be ~ubmi*'~ed with appl~ca,':[,cm for <br />b~Lldi~g peZ'a,i~ or mobile hom~ plice~ <br />~t per~ t. <br /> <br />a Subsurface s~vai;e Disposal <br /> <br />Pe~tt Fees: He~ - $75,00 (~37.50 ~ith slte evaluation) <br /> <br />asgair. Replace, Alteratioa - $25°00 <br /> <br />v~cE ~ZON <br /> <br /> Je~ Lewis <br />Nam~ of ca <br /> <br />section <br /> <br />City, 8tate~ Zip Code <br /> <br />Ta~ ~ot or Account <br /> <br />Lot Size: !76 Acres <br /> <br />Imstaller'sN~ur~ ................ <br /> <br /> Repair <br />~o~'~Moblle ao~__ <br /> <br />Nobtle Home Park <br /> <br /> Numar of Bed~oo~ <br /> <br />Private <br /> <br />1. Proposed subsurface ~age Disposal System Plot <br /> <br />2. Plam~ln~ Evaluation -- Building Pe~t <br /> <br />3, g~lding Pi~ <br /> <br />hereby certify that the InfeCtion cOntatued in this applicat~on ia tru~ and correct <br /> <br />the beet o~ my km~Ied~e ~md belief. <br /> <br />EH-57 rev. 12/76 <br /> <br />si~iu~a ....... <br /> y-/?- xz <br />Da.t~ <br /> <br /> <br />