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1 1 Septic Site Plan - !/—06 jii.,C9( -U62--
<br /> 555-24-004621-EVAL !RESIDENTIAL DEVELOPMENT RECEIVED
<br /> KERSEY,T KEITH&KERSEY,ADENA ZOE �r
<br /> 23527 SANT1AM WAY SE,LYONS 4; ,s•< +,v 'i P JUN UN 1 t0 2024
<br /> 092E17AB01200;0.62 acres
<br /> Total Acres .%Z
<br /> —,.. Lu 0caie: - •u IVot Drawn to Scale -OR- 1 square= 0 feet
<br /> E iQLta-i10K1 671
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<br /> I certify that the above information is accurate to the best of my knowledge.I AM THE i ]Owner or[ ]Authorized Agent.
<br /> NAME(please print): Vetrom LZ02 i s Telephone# 593 II 1_y eft,
<br /> Applicant's Signature: r✓yctS,,, r.S.t•,t" Date: @:l/62/Z
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<br /> Applicant's Mailing Address: 7 J 37 5g-5!.'z E Vn• l t,tR sE,
<br /> City:1.—rem Zip: ns-e, Applicant's email: � Lf (30 QGEf46t .L• tlY)
<br /> S-31-6-2020 G:\Forms\Septic\FORMS\S-31a SepticSystemSitePlanRequirements for SITE_EVALS_2020-07-20.doc
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