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PAGE 1 OF 4 <br /> Holding Tank Plan <br /> Index & Cover Sheet <br /> Component Manual Design References: <br /> Version 2.0, SBD-10855-P (N. 03/07; R 01/12) <br /> Pg 1 of 4 Index & Cover Sheet <br /> Pg 2 of 4 Plot Plan <br /> Pg 3 of 4 Holding Tank Specifications <br /> Pg 4 of 4 Management Plan <br /> Attachments: Enclosures: <br /> POWTS Application for Review <br /> Soil Evaluation Report & Site Map (if applicable) <br /> Holding Tank Pumping Contract if applicable) <br /> Holding Tank Agreement if applicable) <br /> Project Name / Description <br /> Owner Name(s): L)I ! mil ZG1,/i,,&4- Phone: - - <br /> Owner Address: /D/7 6f6,tQKJ Aj/,6� 6A ,,, „ tj Zip: 56,31S <br /> Project Address: <br /> Gil/ &A^ v b f /x Id 369 4,57 _�E❑ <br /> or W <br /> Govt. Lot: ` ,3�� y � of 1/4, Section, T N-R /"1 <br /> �S 5� � <br /> Township: County: <br /> Project Parcel ID#: C7 - 00;3 2 -36--/y-D3--6 65- Cog-o/yar::e <br /> Designer Information <br /> Designer Name: Lt Phone: <br /> Designer Address: 609 S4 ip; 5,11S7/ <br /> E-mail: This space reserved for approval stamp. <br /> License Number: 2,261n5;'a <br /> Remarks: <br /> Signature: G�...__ �� Date: (, /& T <br /> Original signature required on each submitted copy. <br />