HomeMy WebLinkAbout03450 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER e h N Wits -c2-6
ADDRESS /it O ??p�� C co ti v pi PHONE
CONTRACTOR fr$ 1 L, ll ry\bi✓\C� 14 1 800 '13
ADDRESS � PHONE
PERMIT REQUEST FOR QQ NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town c/ ` r Size of Lot a voti 0k1uQ,,q.
Legal Description or Address Pi 0 3 G n 1+/7 Y R d ,2 3 9
WASTES TYPE: (19 DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: pl FO Mew
Number of Bedrooms 3 Number of Persons 3
( ) Garbage Grinder (X) Automatic Washer (° Dishwasher
SOURCE AND TYPE OF WATER SUPPLY• (X) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System? /✓ /3
A site plan is required to be submitted that indicates the followini MINIMUM distances:
Leach Field to Well: 100 feet 1-
Septic Tank to Well: 50 feet 10 '
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet -Mt
Septic System to Property Lines: 10 feet 50 r
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope
2