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RETUF~ TO: <br />Marion County Health Dept. <br />2455 Franzen St. N.E. <br />S~l~n~ Oregon 97301 <br /> <br /> ':'~,' Z-'set. no. 4-74-11 <br /> <br /> , ~nDn-reftmdable fee <br /> APPLICATION <br /> D P^mE T aF <br /> FOR <br />STATEMENT OF APPROVAL OF PROPOSED SENAGE DISPOSAL <br /> <br />PROPOSED USE OF PARCEL 811d Lo~ Size <br />.... IJ e >k:4/. . , .... <br />PRESENTLY DESIGNATED LAdD USE, ZONING AND NAME OF DESIGNATING AGENCY . <br /> <br />PROPOSED METHOD OF SEWAGE DISPOSAL [] ~xtsting Seweraqe System <br /> <br />(~)' <br /> <br /> System Iden~tfioa~ion <br /> Addpess of ~tity <br /> City, Zip Cod~ <br />~'e~an¢ otaCu~ of ~aw~rs o~ ~ewer ~ztenoion~ to e2~a paroe~: <br /> <br /> (b} P[dno fop sew~ ( )h~ ( )h~e no~ been mppr~ved by DEQ. <br /> (e) SeWers ( )haue { )h~ue'~t b~an installed. <br />STATEmeNT OF CERTIFICATION B~ SEWE~GE SYSXEM OW[¢~R (Separate ~tement may be a~aCh~J l'f au~i~,:~e.; <br /> <br />[] P. Preposed New Seweraqe System <br /> Has DEQ approved ~he proposed system previously in <br /> Hdo DEQ issued a Waste Disohapge Pe~it fo~ the p~posed <br />[] Subsurface Sewage Oi~p0s~ System <br /> <br /> Special Instruct ions: <br /> <br /> ~eot ho~es ( )h~w been prepared ( )wiZ~ be <br /> <br />I MEREB~ R~QUES? FROM THB DEPART~ENT OF ENVIRONHENTAL QUALI?Y A STATENENT OF APPROVAL OF ?H~; ABOVE DESCRIBED tqETHOD DF <br />SEwAG~ DISPOSAL FOR THE ABOVE D~SCRIBED PARCE[, <br /> <br /> (for DEQ or Agen~ <br /> <br />~tlty Cl~y 1~ at 24". · App~OVed ~0~ mob~e home s~les ~ot w~th a m~ ~ ~o~ ~plowees. <br />~e ~ the na~e ~ the so1~ tn ~he ~em, we coul~ ~ot app~ove th~s p~ope~ty ~ ~y use <br />which would ~nvolve ~gh~ sewage ~ow~ <br /> <br />Statement, ~f OEq Relative to Above Applicatien <br /> <br /> <br />