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,- <br />12 <br />GTHER SUBMITTAL REQUIREMENTS: <br />1. Twenty —six (233 copies of the preliminary plat <br />2. Two full site copies of an Grange County Tax map (one copy with tax <br />parcels involved clearty marked). <br />3. Where municipal or OWASA sewer is not avei Lab Le, a latter from- the Grange <br />County HeaLth.Depertment certifying the proposed wastewater system- for <br />each Lot. <br />I, the app li cant, hereby certify that the foregoing app Li cation is comp Leta and <br />accurate. I understand- that a. 3210.00 fee (subdivisions of 15 late or Less) <br />3r a $370.00 fae: (subdivisions of 15 lotss or more) is due at the time of <br />app li aati on . A $3.00 per lot fee is due at the time the fi na L p Lat is <br />3 resented for recordation. <br />%PPLICANT'S S GNATURE. <br />]ATE <br />OWNER'S SIGNATURE <br />DATE <br />FEES: Amount � m5- Date Paid -12)0 Z6.�7 Receipt (2243 <br />S <br />r <br />