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Mapits, and other pits. Also <br /> Include location of building reference point(s)'and dimesoil nsions'Spersai system, cesspools,seepage p I <br /> include a permanent <br /> T North j• /',� � ��, <br /> 66- <br /> old <br /> �� �' ` <br /> aod 6eP77c <br /> Vert # <br /> � <br /> r orad �a �caste�e <br /> -7- 10 ` d�"L <br /> v,4 be pvperl�O <br /> ke,4 a v% fl9P � l�n oG-• r��u <br /> Certification corda <br /> ed in a <br /> m was abandoned the system ncrequirements. <br /> nce with Minn.R. 708().2500 and any car�, <br /> I hereby certify A . J n f a c Title: Q°,2 i`' <br /> Name(please print): rr'i' 'r r'Aj '�1 <br /> Address: i 0_I /ti I�� � State: fM►1� Zip. <br /> City: L ` License#if applicable): ' <br /> Phone: r <br /> Signature: <br /> Date: <br /> TTY 651-282-5332 or 800.657-3864 Available in alternative formats <br /> www.pca.state.mn.us 651-296-6300 • 600-657-3864page 2 of 2 <br /> wq-wwfsts4-03 • llIZ1108 <br />