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<br /> I,IE3R1( ORDER
<br /> TAX MAP V- ,--2'2-1 •.-
<br /> „ .
<br /> BLOCK4 : , , ,
<br /> LOT
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<br /> s.•
<br /> : - NAME OF PROPERTY OWNER;
<br /> ' - PERSON REQUESTING.TEaT;
<br /> If different from owns authorized by owner; ---1"YES • :- .NO i : - -
<br /> " I) it) ' i ' ' ci . 41.1; ..' . 2-1 ., 19) • •-;/ ,25? • . C.., /IV.- . ''
<br /> ADDRESS; 0/3; r(7 Z-I - ( Cr/ • • 4, E,f/..-:' ;• r v ...) I' f'...... • ,....• . ::
<br /> TELEPHONE:. 97 2-4_,V-
<br /> _:.:....-............:___„,..... . . . .
<br /> DIRECTION/PROPERTY DESCRIPTION:
<br /> r; -, " ik ! "' ''''' 1' t I • "
<br /> 1 -
<br /> . ' .
<br /> WORK REQUESTED; FEE PAID
<br /> : .
<br /> PRELIMINARY LOT EVALUATION
<br /> P" ' SOIL A . •
<br /> '
<br /> • _ ANALYSIS .
<br /> . .
<br /> ..--"-- _IMPROVEMENT PERMIT INSPECTION
<br /> ------------- .
<br /> p--*" CERTIFICATION OF COMPLETION INSPECTION i' „...---......--,,„.
<br /> PURPOSE OF REQUEST is to determine suitability for ground absorpkion sewage die— :
<br /> nose' system. -- .
<br /> SP-ECIFICATIOR OF PROPOSED STRUCTURE:
<br /> '•':.• : •
<br /> • :1• :. OWNER OF AUTHORIZED AGENT:
<br /> .......... (This signature indicates parMission has been ranted to enter priverty for
<br /> purposes authorized by this work orders) - :;*.? :: `i • „ : -,• :';';
<br /> .- CLASSIFICATION OF SOIL FACTORS (CIRCLE): ::. •.--: •:::::,. :: '-:: ' ':-: :,-'',
<br /> S „ s ..! . , ..../.5...;;;•; •.,..-•.:: :,- '...: ':7;.-- : :-' ;:- (•:•5.--).'
<br /> 1:•••••.,'•:' SLOPE :p.5. TEXTURE :(13 t.STRUCTURE'.cP '.., DEPTH LPS . RESTRICTIVE HORIZONS
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<br /> bATNAG—r., PS) --: PERMEABILITY (PS' "xi..,:. .,.tri 5-"I''''''1`)^:4 ', 11--".
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<br /> pir:.. ^,-..-: 1,y/it-ill:: „ cYs..\.16r;L:
<br /> sIft... CLASSIr ICA fION (CIRCLE);.;--:::::
<br /> SUITABLE : " UNSUITABLE ,i ':::- PROVISIONALLY7SUITABLEI;r! Explanation
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<br /> : . •
<br /> DALE OF ENVIRONMENTAL SERVICES: • -•
<br /> ,STnNAlliPr nc. cAMTTADTAM ProcnOurmi, ccourr.cc. ' 7 ../
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