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Map <br /> Include loCation of building sewer,septic tank(s),soil dispersal system,cesspoois,seapage pits,and other pits.Also <br /> inGude a permanent referen�point(s)and dimenaiona. <br /> r North <br /> ���� O Q/"_Q' j�� 'PU`�t,`•�`✓w`t <br /> � <br /> `��� /<S �V�,RC��_ O`'� ' <br /> �; /lz� G� �. <br /> � <br /> �dV� <br /> / <br /> I <br /> � <br /> ��,, 5_r�� R� , � G1�y�'�- �� <br /> certificatlon <br /> 1 he�ebY cee�fy the system wss abendoned Jn eooatlance with Minn.R 709D.2500�d a►ry foca/requlrements. <br /> Name(pleaee M): -�A Tftle: �— �rV1Qll`—t�=��ws/1� �L <br /> Addreas: �, <br /> City: ��'� �� J-��Q�_ aR <br /> Phone: license#'rf icable): .Z�q <br /> Dete: Sigrmture: <br /> www.pca.itale.mn.w • g51-288-830p • gpp.9g7_3B8q • 77y 851-282-6332 w 800-g67-38gq • Avaflable in altemattve fomrets <br /> wp-wwlatN-03 • 11/21/08 <br /> Poye2of2 <br />