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REQUEST TO ESTABLISH A BOND /9/
APPROVED PLAN N WPO 2016-00086
PROJECT NAME: Theisen & Fadden Residence
(As listed on the approved plan)
All parcels in the project, including any off-site work if easements are not provided,and current owners. Use a
separate sheet if more owners are required. Owner and tax map information must be correct,and plans must be
approved prior to bond estimates being prepared.
TAX MAPS/PARCELs: 127-51A OWNER'S NAME:Charles Theisen III
SIGNATURE: date:
TAX MAPs/PARCELS: OWNER'S NAME:
SIGNATURE: date:
TAX MAPS/PARCELs: OWNER'S NAME:
SIGNATURE: date:
TAX MAPs/PARCELs: OWNER'S NAME:
SIGNATURE: date:
TAX MAPs/PARCELs: OWNER'S NAME:
SIGNATURE: date:
NOTE: If ownership of the property is in the name of any type of legal entity or organization
including,but not limited to the name of corporation,partnership,limited liability company,
trust,association,etc.,documents acceptable to the County must be submitted certifying that
the person signing above has the authority to do so.
The requested estimates arc;
VESCP Erosion& Sediment Control per Water Protection Ordinance section 17-207;SO fee
L7 VSMP Erosion and Sediment Control.Stormwater Management and Mitigation per Water
Protection Ordinance section 17.208;5230 fee required
D Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-435;
& Water& Sewer per Subdivision Ordinance section 14-435; $269 fee required
A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Piease provide
contact information.
EMAIL: chuckth@c-t.net
OR REGULAR MAIL ADDRESS: 323 Catch Basin Rd
Sellersville, PA 18960
Rnvi*4 4110/2011.1101013