Laserfiche WebLink
ADUHESS •... ..5.. .x AUUnto.`� + n <) <br /> YY O <br /> e..l .................................................. ........ .............................:.................... o <br /> PHONQI n PHONE <br /> Z r r <br /> DESCRIPTION 4. Sanitary Facilities: ° o n <br /> 1.*Work: 2. New Building Details No. Bathrooms .... ..... p E t <br /> New Building -��J Type of Con r ction: No.Bedrooms <br /> .......... ;V <br /> Addition W 0 D ar.p,,. Q-...,,. ,.,,, Septic Tank Size Gals. .. IS10 <br /> ... ....... ... .... .< <br /> Sanitaryft.x4... ft. .......... <br /> Fining/Grading ,,, Height._ Stones 1 4a. Absorption Field Site: <br /> ...X <br /> Moving Area 1 ..A.taS.. Soil Type ................................... i i r <br /> .......... .. ................. o <br /> Mobile Home .. ....... Slope .........................: .... n Q <br /> PnvY Perc. Rate ................... ? <br /> 3. Use Id ribs exactly, 1 -family _ • • i <br /> Well Dry Well i <br /> ... ...... home,garage,motel,etc.) � - <br /> Subdivision Seepage Trench .......... m <br /> ... <br /> Camping Unit .......... 4.N..d...51'.Q.t'. Y.B..�d. Privy ....... O <br /> v <br /> -------- --=----------------- . �. 9..... Seepage Bed .......... <br /> Location of proposed structures and existing structures,well,sewage systems, roads,etc., should be sketched in Fig. A. Include road W v - <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property is located at a highway inter- <br /> section, show the inte'r3eetir•g highways and the setbacks required along them and at the intersection- CLEARLY LABEL EXISTING a <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. <br /> -------------------------------- w <br /> 5. Lot Size: - Fig. A. 6. Location: iv <br /> :r n <br /> ft. x .............. ft. — ............................... sq.ft. ....... ......... ....... ......................... o i"n mg" <br /> • it ,•d <br /> 8 Acres 5o Ii t-Itw 2R ,- <br /> - n y <br /> o <br /> ° 4� s <br /> / 44 LA <br /> H <br /> �— f T o <br /> I `J X to )d Oc 12 ootr� e L(o n Z <br /> 0 <br /> Y <br /> ?� <br /> ? <br /> � M In v ym2 <br /> - <br /> m Nn C 'x <br /> on < <br /> Z O m D a m <br /> o <br /> o <br /> nr <br /> Signa urs of Owner or Agent Date i <br /> Remarks✓ GCL--'h'kN4�fw w1 G[c�z/ �,}',�'%! 1ri,,...SGP UIQ.ems....:! ..a.J.Y � Zc��v. -r' 'x : rr <br /> ...:..............................................................................?........................ 9J i . . . . . . ti <br /> Inspection ...................... <br /> Date ................. <br /> .. ........� .......................................... �e a I'i'r o o �' R <br /> �" R <br /> onin Administrator 8 8 8 8 8 8 0.. <br /> NOTE: A preliminary site inspection must be made and site approval granted on all structures involving sanitary facilities I <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be-attached to <br /> this application before•.a permit wilt be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been issued. A"permit may be revoked if misrepresentation 61 any of the information conveyed here- 7 <br /> :With is found to exist. Changes in plans or specifications shall not tie made without approval of the Zoning Administrator. <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br /> _ i <br />