HomeMy WebLinkAbout03239 Au,9- 113-99 12:53P P.03
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER 0 O C i o .- i- Crlithc_
ADDRESS ?309 G. R. 15_9± — PHONE 97c qae - /979
CONTRACTOR . .. e .
ADDRESS.PS7Y7 .(w fSO PHONE 920— & C
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PERMIT REQUEST FOR J4 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 Ne«.? rr4S \ tF, Siz So )(
Legal Description or Address I pig ).)CnlMaCD
WASTES TYPE: DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE _ .
BUILDING OR SERVICE TYPE:MG /J(4 TcCFc{ I Rb Y'1�
Number of Bedrooms _3 Number of Persons -
( Garbage Grinder ( ) Automatic Washer Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: ).)(-0 Cgs ?
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 9
Was an effort made to connect to the Community System? J1/41 / A
A site plan is reaulred 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:
D pth to first Ground Water Table
Percent Ground Slope
2