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44- (e) C <br /> �'n� R RCER ;{ --A',2- 7 C !NSHIP <br /> .. <br /> rAx :,iAP O. 5 AIPP j <br /> OT <br /> NAME OF PROPERTY ( NER: ' - .,.C;-y t , ./, + ]7 .. LaLt <br /> ■ � J <br /> PERSON REOUESTZ,NC TEST: 1 ' <br /> IT -tiT?erent from owner - auttioriied by owner: YES NO <br /> ADaRE55: �' 1 ''' .. <br /> . . ' ;. . . , - ' �.rr` _ / i'? / rid <br /> / / w <br /> TELEPHONE: <br /> : ' i r. <br /> CIRECTIQN/PROPE;RTY DESCRIPTION: <br /> , <br /> \. <br /> w©RK RE1UESTMD: I FEE PAID: <br /> ID: <br /> / P�'ELIMINARY LOT EVALUATION <br /> / SOIL ANALYSIS ot oep <br /> . IM ;QVEt•iEtN PERMIT INSPECTION <br /> ��1 <br /> CERTIFICATION OF CCt-TPL.:'"i IO 4 INSPECTIQ,+! <br /> PURPOSE QF REQUEST is to determine suitab_;qty for ground absorption sewage Pis- <br /> oosa.i syet4m. _.. <br /> SPECIFICATION CF PROPOSED STRUCTURE: <br /> .. .44AP <br /> CI.N R. F AU T HORr.7" AGENT: <br /> (rHis signature ndicat s permission :,a fed to enter r ;.rWCer M•/ for <br /> purposes author ized dy this 'Nark :order.) + <br /> _,.A:. Ir I - ; ICN Cr SCrL FAOTCR c ;CIRCLE) : <br /> S S 3r <br /> SLOPE � X � E � w�UCTJRE CT) DEPTH C� RESTRICTIVE C;:„`5 c U <br /> ,r-........., . .. rC +., .�s N1�A” " 1 J Lt "h a r'wis .� : . . .r,AA TNIt"� <br />