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. .�,_ <br /> APPROVED. FOR SEPTIC --� -_� r_ <br /> o INSTALLATION ONLY" �1 lJ �1 =j <br /> Yt is the responsibility of the <br /> pplicant to coordinate these slarrAtv�taR� orosrat rnrzaIr <br /> e utrements Wit l other, ,.m <br /> q gross. I 2:- , ,', 1 0 f <br /> h ---ma`s- — � : sC '-. <br /> r Total Acre <br /> 0 Druwiy to Swale ,.^ <br /> • 141 Drown to Scale <br /> OR.. I square= feet <br /> 9 .S 1, <br /> - -e cio...,.....- , <br /> . . . . .. .. , . <br /> , c‹- .,t)„,ur <br /> ..':' :i • • r,4,3,,\:soid.„,,y. . . L................ <br /> . . . . . . . . . <br /> . . <br /> 1 . . . • i <br /> . 10 Ni <br /> . . . •d • . . . . . . . . . . . . <br /> 1 <br /> I <br /> I <br /> I certify that the above information is accurate to the best of my knowledge.I AM VIE 1 I Owner or 1 1 Authorized Agent. <br /> N A.M. (pleaseprintl: �:CC fCe 'cS .. _Telephone ti .. Or 40 t 2 <br /> Applicant's Signature; ,,,V °'<"""",....." �Date:, f.. ` ,_,. <br /> Applicant'sMaitiny>Address: 72-0 110 t .�L(C)I t <br /> CiiyiAAA'44M S a Zip; I t S Applicant's await: C){ir .A('), 03.,,.s.,A.C+.a I, ,C...,( G+--4,,,,, <br /> S431-6-2020 C:SForrntLSepticvFORMS S-I IA ScpticSystemSileehanRequirem ns fur srre bWA _2020 07-2o,doc <br /> li44-16 Ohl STATE CERTIFIED <br /> ` ' �,1 N VIA4t Waste Water Specialist <br /> I� , EH-W10147892 <br /> Kimberle�e A.Aldrich <br /> le <br /> 1 , DO- <br />