HomeMy WebLinkAbout03470 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION f
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OWNER M AMY A FLy
ADDRESS CedaA "" Lo PHONE
CONTRACTOR 6 )ARIA ITU ) I, ,-
ADDRESS 14 Ofil'RPiO 1zY ROAM) ) Prig PHONE MD 1•25 2-541
PERMIT REQUEST FOR 94 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 W C r._ size oat 1, 3 t/1 b-cAa4,
Legal Description or Address 4-OT 8 GepPs SU$D N !Pk(
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WASTES TYPE: pj DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: IZE761PPM 11 AA--
Number of Bedrooms 3 Number of f L
V ' Garbage Grinder 7) Automatic Washer JA)., C), Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: 14e10 CAfsTt.c
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 2 M 1
Was an effort made to connect to the Community System? N 0
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