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Page 1 of 7 <br /> TITLE, INDEX AND PROJECT SHEET FOR POWTS PLAN SUBMITTAL <br /> Property Owners Name Property Location <br /> Movie_ Cie F t LIC TatMSi,J 17 €53/Q lie <br /> Property Owner's Address Project Address(if+different from owner's) <br /> Z8S[ G1�1 Q . <br /> City&State Zip Code Phone#60T 3S6- 7i'W or CS1vI Vol&Page n-89 <br /> kos Sk(&l 1, Lc)( S 3 S. '(7 Lot# Block# <br /> u <br /> City <br /> Type of Building Village <br /> - i or 2 Family Dwelling-No of Bedrooms 5 SSk . , ( t <br /> ❑ Public/Commercial- Specify Use- <br /> Filter of <br /> Filter Details <br /> Effluent Type ;1 Effluent(Type& Model) t--,• €1ITh(Ac t"r q$ <br /> ri)Number 1 (Septic) C Basin used(Manufacturer&Size) <br /> 0 Number 2(Highly Pre-treated) <br /> Inline(Type&Model) <br /> fl Hieh Strenuth <br /> Component Manual(s)Used(check all that apply) 0 At Grade Using Pressure Dist Ver 2 SBD-10854- <br /> inground Soil Absorp.Ver 2.0 SBD-10705-P(N.01/01) P(N.03/07) <br /> 0 Pressure Distribution Ver.2.0 SBD-10706-P(N.01/01) 0 Mound Ver 2 SBD-10691-P(N.01/01) <br /> 0 Small Scale Wast Management Project Publication 9.6 0 Holding Tank Ver 2 SBD-10855-P(N.3/07) <br /> INDEX 0 Other—Explain <br /> Page I TITLE, INDEX&PROJECT SHEET ATTACHMENTS(List) <br /> Page 2 ho'r <br /> Page 3 Q„.ore.,Li Pi vs S'Lc;(er rA ClAmbirf <br /> Page 4 m11t0&L 0 c>n io St, <br /> Page 5 VI. r C.0_ <br /> TOTAL ATTACHMENTS <br /> Page 6 )Act_tc0. err�tr�� Seal of Designer,Architect or Engineer(If <br /> Page 7 Stk` rh ,u 0.� Applicable) <br /> Page 8 <br /> Page 9 <br /> Other pages: <br /> Total Pages This Plan '7 <br /> I THE UNDERSIGNED,HEREBY CERTIFY THAT THE For Office use Only <br /> PLANS AND SPECIFICATIONS SUBMITTED HEREWITH <br /> WERE PREPARED UNDER MY DIRECTION AND <br /> CONTROL AND THE THE CONSTRUCTION AND <br /> INSTALLATION OF THIS POWTS WILL COMPLY WITH <br /> SPS 383.33 W.A.C.AND OTHER APPLICABLE <br /> REGULATIONS. <br /> Plumber S t V l?..►\ <br /> Credential# Z. 11 1 b Date le J Z.t//S` <br /> Signature <br />