HomeMy WebLinkAbout72-24 Hrdlicka\,/ . 'w^c/£^
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Bayfield County
Soil Test # ^-)^. 7 ///Cj
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1-10(d))
^U.C^ \J ^LA«<^^-A/a certified soil tester determine that in my professionalI
judgment the following site (see below) is unsuitable for any treatment component other than holding
tanks. Due to soii & site conditions, a thorough soil and site evaluation is not needed to make such a
determination.
Property Owner.'Bi^wZe^ H^ Lie»•^Contractor
Property Address SlG3^ [.'i^fi-tV^ ^
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Authorized Agent_
Agent's Telephone_
Telephone.7/<5- .2^ - '^^Written Authorization Attached: Y or N
Accurate Legal Description is requested:
^ 1/4 of ^ 1/4 Section V Township ^^ N. Range /7 W. Town of C'Lo^^
GovtLot_ Lot_ Block_Subdivision_CSM#_
Volume -Page.of Deeds Parcel I.D#///JTJ'_Acreage_
Additional Legal Description:.
Indicate reasoning for your determination: ^LA^ s~LrL, ^J-s /^-^
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Signature of County Official
Date
Signature of Ceftified Soil Tester
J/'/-^/ '-2^
Date
^OS/t/€
Certification #
(Submit a Ptpt Plan & Fee)
u/forms/soiltestwaiver(KLK)
February 2005
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