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Private Sewage System Plan Index/Chocklist <br /> All plan sets should be legible and pCl Raoent copies,Organized into sets,bound with staples slid covered <br /> by an index sheet such as this sample. No athor pages need he signed as long as the index sheet for Tacit <br /> set is signed. Your caaperation expedites your plan review and shortens plan entry time. <br /> plan ID k ihsncr's Nianc <br /> Lege! scil inn � � A <br /> Ciry/Vrll fa <br /> A <br /> G <br /> Contents Comments/ pec a l n-siG t otts <br /> Page is lnclt*d Two('('.pull ntrAai for oil <br /> picas <br /> t B SOI L ,...r�.� <br /> z <br /> L6-r.jLqtj Return by Mail <br /> 3 N <br /> A4 Rt:�M r Q pax Wier to(County)(Subinittor) <br /> Circle One and Provide Fax#.- <br /> 0 <br /> :0 Call for Pick-Up. i <br /> Oiher <br /> 1.the undersigned.hereby eet'ttNy that the _,Seat(•i�ppltcadte) <br /> plans and specifications submitted <br /> herewith were prepared ander my Ca d0 "ally <br /> direetinn and('sutral. <br /> PiaiabCUllesi{�er 41•�•�'1n+'�:aietu N �. <br /> �nuE <br /> &- Ra v kl S pp�. FpS OFC SGS <br /> Wiltess City State pEPr"' SpfEZ� <br /> 2.7710 UJIFASTViz ,WI - <br /> Siguawrc T <br /> F" <br /> r GCR <br /> tarOgice Use Only <br /> Attachments: <br /> nppltcataar <br /> sell&ske evaluation RECEIVED <br /> F <br /> Needed for Molding rank submittal: SEP 1 71997 <br /> One espy of natulzed holding tank <br /> agret:nlCat.Wrlgblalsmcouary) SAFETY&81065• DIV. <br /> Needed for At-Grade Submittal: <br /> Udglnai sig�d and notadud <br /> Application for"U�of an At- <br /> Uradd' 897= 21202 <br /> ('aunty on-A)ta <br /> One atldltlemi set of plans SHO-106S(N.a 1ISfb) <br />