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Private Sewage System Plan Index/Checklist <br /> All plan sets should be legible and permanent copies,organized into sets,bound with staples and covered <br /> by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each <br /> set is signed. Your cooperation expedites your plan review and shortens plan entry time. <br /> Plan ID# Owner's Name <br /> S97- 1-091S -roti F>0VjMjqr4 <br /> Legal Description Address <br /> Stec. Z `40 17 SSSS P D Coon/ RAPT M+ <br /> CityNillag o County <br /> uNlolJ <br /> �- q-7 0AywAW <br /> Contents Comments/Special Instructions <br /> Page# Included Two copies needed for all <br /> plans <br /> 1 I Plot Plan <br /> 2 A $ Plan View/Lateral ['Return by Mail <br /> Q A Cross Section <br /> Tank&Pump/ Q Fax Letter to(County)(Submitter) <br /> 3 Siphon Information Circle One and Provide Fax#: ( ) <br /> -501L -TESr <br /> 51 Ifump CUR✓& 0 Call for Pick-Up: <br /> Q Other <br /> I,the undersigned,hereby certify that the Seal(if applicable) <br /> plans and specifications submitted <br /> herewith were prepared under my <br /> direction and control. <br /> Plumber/Designer License/Registration# <br /> 1(HAR49 80RAIS 3 q 7-6 <br /> Address City State <br /> 2 760 9w 35 090SVCR ,W I , <br /> Signature <br /> For Office Use Only <br /> Attachments: <br /> Application <br /> Soil&site evaluation RONA.& <br /> Fee 0,,M/AYNr�y <br /> Needed for Holding Tank Submittal: APPROVED One copy of notarized holding tank <br /> agreement.(Originals to County) <br /> DEP ENT OF COMMERCE <br /> Needed for At-Grade Submittal: DIVISI F ti DY EOYIDl" <br /> Original signed and notarized <br /> Application for"Use of an At- <br /> Grade" SEE COR SPONDENCE <br /> County on-site <br /> One additional set of plans SBD-10268(4.01/96) <br /> S97 = 20998 <br />