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slim PLAN FORPROPOSEDRESIDENTIAL DEVELOyRENT RLI _ na1 l Z) <br /> Site Address: ///33 f),'AW - /-At l y a 1A-S <br /> Township o Total Acres <br /> 5 5 Range _ section i? Tax Lot RECEIVE <br /> Subdivision Block . Lot 'AUG 29 2024 <br /> El Drawn to Scale:l 2s' o© Not Drawn to Scale -OR - 1 square= feet <br /> . .. . . . . . . . . . . . . ..... . . . . . . . . . 4 _ _ . <br /> 1)6)0' __ <br /> -�'- - .t - - - - _ _ _ - _ _ - <br /> EIc` a..,-s <br /> Cam' a' <br /> . . _ . . . . - - -50_ - i L Are..-to 2' <br /> STATE CERTIFIED X� - - _ <br /> • - Environmental Health Specialist O <br /> - _ . erw EM-S-10117541 la Gig /o— <br /> ,-.)t 41 <br /> - • Mato W.•Knmiser' i - . . . . . . .. - <br /> • • • . . . . . . . . . . 0 . . . »o . . . . . . . . . _ <br /> I <br /> -w, ti� . _ . 6tf1 - - - - - - <br /> . . . . . . . ( . . . . . . . . . . . . . . . . . . . . <br /> I certify that the above information is accurate to the best of my knowledge.I AM THE(I Owner or[-j Authorized Agent. <br /> NAME(please print): 1,- ctr- IA sZ7vs— Telephone# ....SV --&73 -7/5 7. <br /> Applicant's Signature: ,t, _A <br /> .Bate: =� <br /> Applicant's Mailing Address: 21-71 if ,...__J e..._Z,e_ AL..._,f ,../€11 . <br /> City: g,--4 v -+gLt_ MP: 7��`l Applicant's email- 40,11u2(P1 tA--"e--,5' r'C.-5 d'17P-6� 1 <br />