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<br /> SITE PLAN FOR PROPOSED RESIDENTIALrDEVELOPMENT
<br /> Site Address: r! 1� IV, SoT1-i �' i ( �0.� (_=Talc O rZ q 7 3 (J
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<br /> Septic Site Plan ```
<br /> rrill'' rri 555-21-002893-AUTH A
<br /> O C7 X > • • • • 1' • CAPEK,SCOTT
<br /> 708 NORTH SANTIAM HWY, GATES •
<br /> • • ® � -. • • \. _ • 093E27CA00300; 0.45 acres -
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<br /> I certify that the above information is accurate to the best of my knowledge.I AM 113.N.,[ ] Owner or[ ]Authorized Agent.
<br /> NAME(please print): S(0'•4 1(.7 rt..f,e i , �, / Telephone# i alp 8 - #':&.,')
<br /> Applicant's Signature: ,.11 ,. 7,.�i r t x
<br /> -. ._. x Date: i '• ,^ ,
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<br /> Applicant's Mailing Address: f 0 9 ( . -t'�f tr1'1 r '' C,/1/1 (A i !'.
<br /> City:k-f'O t' ' Zip: otF 4c-!( e Applicant's email: V t le)CA, fP. 'i 3 4J �,W i' „ F,f.�\ (t f�
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<br /> S-31-1-2017
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