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Ae, 1,1P3 <br /> .....,.._.._.__._., _..---.._...�_ in accordance with comm 85.Nis. Adm. code County <br /> Attach tnrriplete site plan on paper not lees than 8 x 11 inches in See.Plan must �T -- <br /> Include.but not Invited to vertical and haraondl reference point(BM),direction and Parcel LD_ <br /> percent slope.scale or dlorensions.north arrow.and location and distance to nearest road. 02 -3 32 -o <br /> Please print all information. ReM Date <br /> PersmW iMomation you pmWe may bouses lar sacpasy PrxPm (wwacy raw,s 15-04(1)(mA /.2' -0`t' <br /> Property Owner Property Location - <br /> ,• GovL tot J•w 114yF 114'S )1 T S7 N R / E(o(tg <br /> aAAPMpWFy Owners Mailing Address - Lot# Blotic# Subd.Narrle qr CSM# <br /> 2 .tP F C Y z ' .2 r4Fi9W,4 r <br /> city State Zip Code Plane Number ❑City ❑Viage ((]Town Nearest Road <br /> S 1 (71 r) yur. <br /> New Construction Use:(g'ReaSential l timber of bedrooms z Code derived design flow rate ?ytp GPD <br /> ❑Replaosatent ❑ Pubic or cemmerdal-Describe: - <br /> Parent material Aellw&fne Flood Plain elevation ff appiode R <br /> General rec canxnen� �/ � sJj,yn�,ff . . <br /> enol remnrnerrdations: �.✓ <br /> Boring / <br /> Boring F- # Pit Ground surface dev. 9,9 21, fL Depth to Fftm tactor > 72- in. Sail Application Rate <br /> Ha;, a <br /> on Depth Ddrrarlt Color Redox Description TerStructuree Structure Consistence Boundary Roots GPDItta <br /> in. Munsell Qu.Sz. Cont Color Gr.Sz Sh. 'Eff#1 6082 <br /> z , 7 G <br /> c--33 <br /> w I M 7 16 <br /> Si-727.; c- Aftl <br /> Fc aw uS SBoring 0 . • air S. <br /> Baring <br /> Q Pit Ground Wallace eler. R Depth to imiire taolar 5-Y (n. Sora APWkaton Rate <br /> Hamm Depth Da vwd Color Redox Description Texture Structre Boundary Rods GP2Ifl1 <br /> in. Munsell Qu.Sz Cont.Color Gr.Sz Sh. 4W 'EMI 'EIIR <br /> O-S/ S LS C S 1 <br /> -X S <br /> /-5-yAvZ <br /> Effluent#1=BODa>30<22D mg&and TSS>30<150 nngll #2=BODa<30 nngll,and TSS<30 mglL- - <br /> CST Nontiter <br /> (Plus Print) ^ ?2 d <br /> r -Date Evaluation Conducted Telephone Nuallm <br /> Address Fogerty Plumbing & Perk T sting 71r S-9/O� <br /> 28288 McKenzie Rd. <br /> �� 9 <br />