HomeMy WebLinkAboutEHPR-12-11-13581.TIF
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Improve. Permit___Authorization to Construct~epair Permit___Oper. Permit ~ '
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Owner/Agent ~.... (~LLC- Phone ;1..~7J-..s
Address (Jyu r~e e::r tll(~ Subdivision ~
I Section/Block/Phase Lot#
Facility: House Mobile Home
Multi-family~ Other
# Bedrooms ~ # Seats # Employees
Hot Tub or Spa yes/no Special Fixtures
Basement yes/no Basement P1Umb~es/no
Water Supply: Private Well_____ Public
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Type of System: Trench ~ Bed Pump Pump/Panel Panel LPP Other
Tank Size: Septic Tank Size ~ ~ Pump Tank Size ~
Nitrification Field: Total Square ~et JdOl) Depth of Stone la..' / Bed Size
Trench Width '?/ Total Length of All Trenches l.f /0 Number of Trenches
Individual Trench Lengt~/ JOd//OO / ~d /____ Feet on Center ~r Maximum Trench
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Topo ,. ,v) ~lope
Texture ~
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Business
Other: Tax Map #
Zoning Approval #
Application Rate
100% Repair Area
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Depth ..3 ~
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Distance of Nearest Well
*DO NOT INSTALL WHEN WET*
Structure
Clay Min.
Soil Wetness II
Soil Depth II
Restric. Hoz. at II
Available space yes/no
Overall Class S PS U
Comments:
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**NO GUARANTEE OR WARRANTY
SYSTEM WILL FUNCTION**
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IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS
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*Improvement Permit has no expiration date and is transferable, but may be revoked if site
plans or intended use changes for the proposed facility. An Authorization to Construct is
valid for (5) five years ~om date issued and is not transferable.
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Installed B~__~ Date(rJ--~~ sanitarian.t- ~"
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Green - Building Inspection Authorization to Construct
White - Office
BIue - Building Inspection Operation Permit
Yellow - Owner! Agent