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HomeMy WebLinkAbout03614 INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION 'OWNER J O F f3C1:.T0& E /MEL /y')c. G ADDRESS ©L1'8 9 R Os E Lici PHONE 10 q OS7/ CONTRACTOR Darn o a n1ST4? U 071 010/ / ADDRESS 0167 FAIRWAY LA AJ E ro s. PHONE q — 6 e0J 7" PERMIT REQUEST FOR (X) 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 61- ENwosv Sj'gik6> Size of Lot /C..c Legal Description or Address Mccet D 4 VICD C4E157EGs IT Sex3PW ( *.dil+er WASTES TYPE: (Q DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: e e5 I DE NC. E Number of Bedrooms Number of Persons 3 ( ) Garbage Grinder (4 Automatic Washer (x) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: (A WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: 1101}1EOWNEC5 (CHRsSTete ito q5 5 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: MIL Ir 5 Was an effort made to connect to the Community System? 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 NC)va E IVOCO TE,C e D Percent Ground Slope &' t 3' 2 N N 4. N J . ^ , 4 y..I N !1 1• zc z V cd O • N a ^� 4 di fir- . r,�' g cl cy 1 N - ❑� �w�] g . ai ti p O b 0 7 U td U N Iv --I . 0 1 , 1 -t c l i o E a ei e r B a a o 3 0 0 O 3 �.1� S o 0 �. zb V re A �z i