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aLA ób3Y3S <br /> SITE PLAN FOR PROPOSED RESIDENTIAL DEVELOPMENT RECEIVED <br /> mi <br /> Site Address: 21171 Ave, 44ii ok /73/ JUL 05 2024 <br /> Total Acres 2,oV <br /> TAXLOT <br /> 0 Drawn to Scale: .17Not Drawn to Scale -OR- 1 square= feet <br /> fi_RI5oRVLE 211241 <br /> . . . . . . . . . •. •• <br /> J;> 11,` . . . . . . . <br /> • . . . . . • • va Tr • - • • <br /> . . . . . . . °A.; , k°.•61 • • f 5r. lAjt 11 • • • <br /> •. . •• 14CP . . . . . . . • • . . . . . <br /> . . . . . . • • • • <br /> Rzeiacio tv)5 <br /> • •(7-7 • • • 1 1 1 1 . WrTli ..„14F1E:117 . . . . <br /> oillat v4k <br /> . . . . . . . <br /> • iisrtrxre-y +-q. Ss-ke)20.41-Amn. <br /> . . . . . . . <br /> bOX OPO r 1 krkO°0 .. .. <br /> 9,0 <br /> • <br /> fift( u . " <br /> . . . . . . . . <br /> . . . . . ' • APPROVED FOR S.EPTIc <br /> . . . . . . . STATE CERTIFIED . INSTALLATION ONLY" <br /> Environmental Health Specialist <br /> . . . . is the responsibility of the • • • • <br /> - EH-S-10117541 <br /> (cart to coordinate•these. . <br /> • V;;$- <br /> r requirements with ati others. <br /> • <br /> Matt W. Knudsen <br /> • <br /> 7(tr/A1 <br /> I certify that the above information is accurate to the best of my knowledge.I AM THE[ I Owner or[ I Authorized Agent. <br /> NAME(please print): Jess Risenmay (Action Drain) Telephone#503-932-2401 <br /> Applicant's Signature: /7.-- Date: C )/0 ZS/LT <br /> Applicant's Mailin ,36 h ay SE <br /> • Salem <br /> City: zip: 97317 Applicant's I jr.actiondrain@gmail.com <br /> S-31-6-2020 G:\Forms\Septic\PORMS\S-3 la SepticSystemSitePlanRequirements for SITE_EVALS_2020-07-20.cloc <br />