HomeMy WebLinkAbout03543 IND'VIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER 7,e CAR/ AAA AARp.R," 4 - weR 14.r,.i TRH. a7'
ADDRESS 0eu h4/ t! 2 f?,.V/o (L 2,656 PHONE 9M -/o as " - il a
CONTRACTOR h ntn e// (?n/z P. f f
ADDRESS /.? IR -f/ e ea/ PHONE 97o 6z s" 5
PERMIT REQUEST FOR ( ) NEW INSTALLATION (df ALTERATION (✓rREPAIR
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 R ; n a Size of Lot / N / A.
Legal Description or Address Cnaa -}'y ) ?d ,? 97 gi f (,e Cn /A.
WASTES TYPE: (%) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: /-1 n Inc
\ umber of Bedrooms .3 Number of Persons 1
( ) 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? 776
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 f, frfi
Percent Ground Slope Arr.
/ ° Z /
�.9 \ \ 1. 2