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_1 i <br /> SITE PLAN FOR PROPOSED RESIDENTIAL DEVELOPMENT <br /> • Site Address: /0 2-6xc4 `d/4/e/(4 I (/ 4= <br /> L y"' ;,v S c% ¶l 7 3�� Total Acres �' <br /> TAXWT / <br /> ❑ Drawn to Scale: •❑ Not Drawn to Scale -OR- 1 square= eif feet <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): -5 Z r l / `s u File— Telephone# -r -- (/-/ 2-2- ' <br /> Applicant's Signature: / �,N Date: Zf� �2. 23 7�� <br /> Applicant's Mailing Address: ,`I7 �✓i 0iif` LAire L� -L-� ' ' c7 �`--'r <br /> City: Zip: Applicant's email: J <br /> S-3 1-6-2020 G:\Forms\Septic\FORMS\S-3la SepticSystemSitePlanRequirements for SITE_EVALS_2020-07-20.doc <br />