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De~pa. cement o£ Env~:m~tal <br />1234 $. <br />~o;~an~, Oregon 97205 <br /> <br />City <br /> <br />TaX Lot or Account <br /> <br />GENERAL DESCRIPTION <br /> <br />Ne~COnstruction <br /> <br />LL Re~air <br /> <br />Install&~ion will serve~ House <br /> <br />Mobile Home -'"~', Mobile Hc~e Park <br /> <br />Co~m. ercial Building <br />No. of Living Unita <br /> <br />No. Bedrooms <br /> <br />Water Supply: Public <br /> <br />~UIP~D EXHIBITS <br />1. <br /> <br />3. <br /> <br />Pro~s~d subsurface Sewage Disposal Syst~m~ <br />Planning Rvalua~-~on - Building Permit (Local Opt/on), .......... <br />oth~r (Local Option) Bu/ld~r~ Plan~ <br /> <br /> <br />