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Department o£ EnVironmental Quality.', <br /> <br />Portla~, ~on 97205 <br /> <br />Land Quality <br />County <br /> <br />Application to the Department of Envi~onmental Quality <br /> <br /> for a Permit to CoD~trug~; a <br /> <br /> New ~r ~r_ a subsurfaoe Sewage <br /> <br /> Permit Fees: New $30,00 Rc~3ai=,. ~%cratlon $15.00 <br /> <br />A. R~FEP~LNCE TNFOP~{A? ION <br /> <br />City <br /> <br />B. GENERAL DF~CRI~TION <br /> <br />New Constru=tion_~_~--~~ ~Repa ir <br /> <br />Installation will serve= House~ / Mobile <br /> <br />Mobile ~ome Park <br /> <br />Cp~,ercial Buildin~ <br /> <br />Other (~lai,) <br /> <br />No~ of Living Units <br /> <br />Water Supply: <br /> <br />Private ~Garbage <br /> <br />1. ProD~sed subsurface Sewage DiSposal Sys~ <br /> <br />Plot Plan <br /> <br />2. Planning Evaluation - Building Permit (Local 0~ti~.,~) <br /> <br />3. Other (L~eal option),, ~uildi~ans <br /> <br />I hereby oertify that th~ infc=l~atiun oontaiaed in this ap~31ication is tr~e and <br />correct to the best of my knowlec%ge and belief. <br /> <br /> \15 <br /> <br /> Date <br /> <br />Interim F~n~ #1 <br /> <br /> <br />