1. LOCATION MAP
      2. PROPOSED DIKE
      3. ALONG THE
      4. NAME OF STREAM
      5. AT OR NEAR
      6. TOWN, TOWNSHIP & COUNTY

LOCATION MAP
Scale: 1 in. = _____ mi.
NOTE: Use of U.S.G.S. quadrangle map(s)
is recommended.
(If Required)
REGISTERED PROFESSIONAL
ENGINEER’S CERTIFICATION
“I
(Name)
do hereby certify pursuant to the penalties of 18 Pa. C.S.A. Sec.
4904 to the best of my knowledge, information and belief, that the
information contained in the accompanying plans, specifications
and reports has been prepared in accordance with accepted
engineering practice, is true and correct, and is in conformance
with Chapter 105 of the rules and regulations of the Department
of Environmental Protection”
PROPOSED DIKE
ALONG THE
NAME OF STREAM
AT OR NEAR
TOWN, TOWNSHIP & COUNTY
PROFESSIONAL
ENGINEER’S
SEAL
(If Required)

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