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........................................................................�................. .....ADDRE S ADDRESS ................. ` .O <br /> E —Mt <br /> C <br /> ................................................................................ _. <br /> < ; <br /> PslONE O 0 O <br /> PHONE <br /> DESCRIPTION <br /> Z N <br /> 4. Sanitary Facilities: o `S <br /> 1. Work: 2. New Building Details No. Bathrooms 'p <br /> ...... .. <br /> v <br /> Now Building Typ¢pf Construction: No. Bedrooms .......... <br /> Addition X t—1 Septic Tank Size Gals. <br /> Sanitary I ....... ... P 4- <br /> .......... Size ...... ft. x .......(T.... ft. <br /> Filling/Grading Height...I-Z. St les 1 4a. Absorption Field Site: <br /> Moving Area ....... 2!f <br /> ... ................... Soil Type .................................... i r <br /> Mobile Home .......... Slope .......................................... <br /> Privy . 3. Use (describe exactly, 1 -family Perc. Rate ................................... d <br /> Well holgDry <br /> garage,mo el,etc) y Well m <br /> Subdivision 'reeK STz p <br /> ................... <br /> ..................... <br /> .... ..•. .......... .......... <br /> Camping Unit Privy <br /> -------------------------------------- Seepage Bed <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. I C <br /> Include road setback,side and back yard dimension and location and setback from all bodies of water. If property is located at FL <br /> a highway intersection, show the intersecting highways and the setbacks required along them and at the intersection. <br /> CLEARLY LABEL EXISTING STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------------------- <br /> 5. Lot Siz -------- o <br /> I Fig. A. 6. Location: ; <br /> ..Z:.?r... ... ft. x ... .... f�t.�—��.,.;(.`�'.�.�.$y.......... sq.ft. <br /> c ........... <br /> 0 <br /> 0 910 <br /> \ � <br /> 0 i <br /> N <br /> :W <br /> T w <br /> 36 :C4 <br /> Id � ° <br /> 6c rt�' M <br /> �Il—�(j N �aaaff p' Cj n) <br /> I�t,bl 13 f g 1 I v — <br /> �s <br /> m w o m m cvw <br /> 0 COO <br /> II� <br /> E. <br /> 9.11 <br /> X : <br /> Signature of Owner or Age m <br /> Dat nA • 0 <br /> Remarks -n <br /> .................................. m .. <br /> CD :, <br /> . . ..................................................................................... <br /> .......................................................................................... ... .... ~' g g <br /> . . ........ N Oa N <br /> M <br /> Inspection Date ....................................... �i <br /> Zoning Administrator $ g $ g N <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities before construction <br /> can begin. In the case of sewerage disposal systems,a copy of the percolation test must be attached to this application before a permit will <br /> be issued. Do not purchase or install a septic tank,do any plumbing or start any building until a permit has been issued. A permit may be <br /> revoked If misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be <br /> made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />