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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#_ _ �O Owner's Name <br /> 9-7 <br /> Legal Descscription Address <br /> Ec RVSTAL, hL-53VES <br /> City/Villag own County <br /> rRAve E Sup,40T <br /> Contents Comments/Special Instructions <br /> Page# Included Two copies needed for all <br /> ply <br /> 1 Plot Plan <br /> 2 SOIL 0 11J S• ( ]Return by Mail <br /> p4 R £A^1 0 Fax Letter to(County)(Submitter) <br /> A tO vc c u mlM ( -s Circle One and Provide.Fax#: ( ) <br /> 0 Call for Pick-Up: ( ) <br /> 0 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 /> &KARv 40picir4sqZ(c <br /> Address City state <br /> 21-74o H 35 WEss,�a �Jl.�lb13 <br /> Signature II <br /> For Office Use Only <br /> Attachments: <br /> Application P.O.lq <br /> Soil&site evaluation C �,s, <br /> Fee °ndrhOnally <br /> Needed for Holding Tank Submittal: A Pp <br /> One copy of notarized holding tank EPq D <br /> agreement(Originals to County) Of rOF MEIiI <br /> Needed for At-Grade Submittal: O1N� <br /> Original signed and notarized SFE <br /> Application for"Use of an At- COR��c„_ <br /> Grade" <br /> County on-site <br /> One additional set of plans SBD-10268(N <br /> 'RECEIVED <br /> S97 = 20997 AUG 25 1997 <br /> SAMY&BMS. DIV. <br />