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~nvironmen~al B~al~h Servi~.a~ <br /> <br />Department of Env~rO~n~al Quali~y <br /> <br />men~ permit. <br /> <br />for ~ Permit co Cen~ru~._______~ta New or~R~p~r <br /> <br />Permit Fea~: N~ - $75.00 ($37.50 with ~ite evaluation) <br /> <br />R.~ep~_ir, P,e~laee ~. Al_t~ra =ion- $25. O0 <br /> <br />~. ,GF_~RAL D~SCRi~IION <br /> <br />Lo: Size__ 6=8 <br /> <br />Zn~tallation will ~erve~ Bouze x ~b~le Hom~ ~b~le Home Park <br /> <br />1. Proposed Subsurface ~ewage Disposal ~ys:em P~o: P~an <br /> <br />2. Planalog ~vai~atiom -- Building Perm/: <br /> <br />3- ~u£1dlng Plmn~ <br /> <br /> the bes~ of my knowledge and belief. <br /> <br /> ...... <br /> Date <br />~i-~7 r~v. 12/76 <br /> <br /> <br />