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......................................................................... ............................................................................................ <br /> xIESS ADDRESS <br /> ............................................................. ..... . ................................................................................... J <br /> o' <br /> PHONE PHONE H p <br /> Z r . <br /> DESCRIPTION 4. Sanitary Facilities: ° 0 lv <br /> 1. work: - No. Bathrooms <br /> 2. New Building Details .......••• <br /> New Budding .,, ,. Type of Concoon: No. Bedrooms .......... a ° y <br /> Addition P(LM� ti <br /> ?C... ................. Septic Tank Size Gals. <br /> Sanitary ... ...... Size .............. ft. x .............. ft. .......... <br /> Fil lingi Grading .......... Height............. Stories ............... 4a. Absorption Field Site: yam: i <br /> Moving .......... Area Soil Type .................................... <br /> o <br /> Mobile Home .......... Slope .......................................... .. <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... '• <br /> Well ........., home, arage, motel, etc.) Dry Well .......... <br /> Subdivision ., „ ugh r, Seepage Trench .......... 9) <br /> f '........................................ <br /> Camping Unit .......... Privy .......... <br /> .................................................... <br /> ------------------------- Seepage Bed .......... <br /> -------- <br /> Il of proposed structures and existing structures, well, sewage systems, roads,etc., should be sketched in Fig A. Include road <br /> setuack, side and back yard dimension and location and setback from all bodies of water. If or is located at a highway inter- c. <br /> section, Show the intersecting highways and the setbacks required along them and at the intersection. CLEARLY LABEL EXISTING 5 <br /> STR-CIURES AND PROPOSED STRUCTURES AND ADDITIONS. '^ <br /> ----------------------------------------------------- o' <br /> ----------------- <br /> S. Lot Size: Fig. A. 6. Location: <br /> ................ ft. x .............. ft. . ............................... sq.ft. ............................................................................... <br /> J/ 'Gs'✓��� v' p O <br /> 3 <br /> U] <br /> k <br /> c G <br /> o <br /> I <br /> Yr57 r>y tlI ! �l n� 7o die s "t T6 `J <br /> Do <br /> µige 1 <br /> tw cn r Z <br /> /// ,/ CD 0 <br /> o0m " ➢ am <br /> o :�` / <br /> ll � \ <br /> .., �G...../. ........................................ / n� G7 <br /> p .. . ....� L....`...�:� VVV <br /> J : <br /> signature o` wge'r or Agent Date i �� � C <br /> Remarks ............V...C.1+.% .4c� �c rC�t S f i� (`.� C. / h^OCh� I T <br /> ( . . ........].......... ................... . <br /> L................re............�...................... <br /> X <br /> m <br /> ........... ..............�.�' 5..G..t.....s y. `. ". '....................... E'2,. {Clli/ C'.......................... <br /> Inspection. Date ....................................... i ti N m m <br /> . ... ..... .. .... ........... ..................................... pY UI pl O N <br /> V m <br /> Zoning ministrator E 8 8 0 8 0 vi <br /> 'OTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities <br /> efOre construction can begin. In: the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> ils application ,before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any. build <br /> ig until"a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed here <br /> ith is found to. exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFIvCE AND APPROVED. <br />