HomeMy WebLinkAbout03558 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER ) / /,O 6- ,C /,wEIP
ADDRESS flax / / /G, /965/91-7) Co t /6R/ PHONE 970 - 9027- 99C<
CONTRACTOR 0 Iv Ai — D.9 // O t U %�.�
ADDRESS PHONE 9 70 - 927 5�y 6
PERMIT REQUEST FOR ( 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 /+l / 9Se u /2; 413— e.4,84 4fl2 5elhot P57 Size of Lot * f "feeders
Legal Description or Address 7V5 /,v4t/C4 rn/9 P g. , <:.� tZ , C'o
WASTES TYPE: (60_ DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: ie 1 5 1 PE /T /4) L ����
Number of Bedrooms '- relic/ ,P -t 2 UP Number of Persons lam( /
( ) Garbage Grinder (SG) Automatic Washer (A) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ()() WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: i(l//9
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System? if./0 SLCU /CZ ff "/tj /L G
A she plan is required to be submitted that indicates the following MINIMUM distances:
Leach Field to Well: CSC L s ; tJ ) 100 feet
Septic Tank to Well: 1,7719e #S0 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet ,''h`. /e:
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 ? (vt t / 4T A42't 708 Pou/A
Percent Ground Slope ,4 / / &k 0 — ' a DR' D,PM/° IA; 90 Rory £»r o s E) 3
2