HomeMy WebLinkAbout03487 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
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OWNER /✓'
4A/C 4 PJ GL LO
ADDRESS ( ti /A7!/woca PHONE 9 7z7/
CONTRACTOR L # 'VS .e 2-
ADDRESS Al W r/04 PHONE _42f • /3
PERMIT REQUEST FOR .(X) NE INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area • h 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 �� AI f vo ° c J 5 oQ Size of Lot , 4C*d
Legal Description or Address 2 C'T Al -/ni / /7 ice OWE Lcl'U&
WASTES TYPE: ( DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER � DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms 3' Number of Persons - i
(t- Garbage Grinder (i) Automatic Washer ('-t Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: (v)' WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: / /A o9ti&_ /j-'s r,, s2 D/s 72 t: l
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 4 s 7zeaC
Was an effort made to connect to the Community System? GA-6
A site plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
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