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Site Plan Worksheet
Place a mark (X) beside each item
that has been indicated on your site plan. Incomplete site plans
will be returned to you for completion. Remember:
Your property will not be scheduled for an evaluation until
we have received a completed application, site plan, and all
proposed items are marked on the property.
| _____ |
The Dimensions of the Property |
| _____ |
The proposed location of all
structures (e.g.: facility, wells, water lines, out
buildings, pools). Show the distances from the road and
the side property line to all structures. Be sure and
give the dimensions for all the structures. If you are
unsure as to the structure size, please show the
dimensions fo the MAXIMUM area of the lot that you
anticipate the structure will cover. |
| _____ |
The site you would prefer you septic
system to go in. |
| _____ |
The preferred driveway location. |
| _____ |
The proposed well or water line
locaton. |
| _____ |
A north arrow or other sufficient
directional indicator. |
| _____ |
Any proposed structures or
improvements to the property such as garages, workshops,
pools, etc. If there are none, circle
"N/A". |
| _____ |
The location of any existing septic
tank systems and wells on your property and on the
adjoining property within 100 feet of your property line.
If none, circle "N/A". |
| _____ |
The location of any easements or
rights of way on the property. If none, circle
"N/A". |
| _____ |
The location of any designated
wetlands on the property. If none, circle
"N/A". |
_____________________________________________________________________________________________________________
USE THIS SPACE TO DRAW YOUR SITE PLAN:
| The undersigned person
agrees that he has read the above requirements and has
supplied us with applicable information to the best of
their knowledge. It is understood that this site plan is
an integral part of the application for Environmenta
Health services and any permit applied for herein shall
be void and of no effect if any of the above facts are
not true. If you have not corrected or completed the
items noted above within 90 days, your fee will be
forfeited and your application returned. |
| _______________________________________ |
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________________________________________________________________________________ |
| Date |
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Signature
of Applicant |
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