HomeMy WebLinkAboutEHPR-07-2012-16033 (2).TIFi
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Lot Etraluation Iirprovement Permit Repair Permit~Car~letion P~~ni~a~~
Owner/Agent ~ Oi(`~Lr,r~r~ ~~~.~,~.~1~'(~it-' Phone
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l~+ddress f;1 ~ ; Ch ~I LE~~~.~~~~
L~ 3 L ~` ': ct ion Block Lot #
Lot Size Directions: , ~ ~.Cc~
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Facility: House~C Nbbile Hane Business : ottps: Loni.ng lapproval yes/no {f
Multi-family Other : 100% Repair Area y~es/no
Bedroar~s Baths Seats ~loyees : GPD Flow Application Rate
Garbage Disposal Special Fixtures :~AIR I~ICE: F~AIRS MUSZ BE WITF~i 30
Basement yes /no Basement Pltanbing yes /no : DAYS OR ~A7CS F'1~M L1A7£ OF PEFd~'P.
Water S~ipply: Private Public '
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Z~ipe of S~staan Trench Bed S~stem Other ( Specify )
Tank Size: Septic Tank ~~(I s'1~~r'~ Ptar~ Tank
Nitrification Fi,eld: Total Square Feet ~~0 Depth of Stone ~Z~ Bed Size ~~ ~/ C
Trench Width Total Length of All Trenches IV~anber of Trenches
Individual Trench Length / / / / Feet on Center Maxim~an Trench Depth
Distance to Nearest Well Lot E~raluation: Appi~oved Disapproved
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Sketch of Lot ~aluation Site - System Design - Final ~;
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Permit Date (Z ~ ~ 5
(Lot E~aluation and Improvement Pe~ai~ v_~d ~f$e~r 36 monxhs)
Owner/Agent Sanitaria~ _~ ' ' Ir`~ ~/,r''~
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Installed By_ ,~~ ~~~~ ~ cc~~'~ ~~ ~~r'1~-r~ 2~ Date l/L ~~~ Sanitari~_1 ~.~ ~,; ~~+~- ~. '~~ F~~
(Note any~changes/infonnati n in red or by sk,etch on back)
Zbno S PS U arainage S PS U Depth S PS U Restrictive Hoz. S PS U SQaoe S PS U Soil S PS U
III L~oans: Sandy Clay, Silt, Clay, Silty Clay~.6-.~ Na Clays: Sandy, Silty, Clay .4-.2
WHITE • OFFICE COPY VELLOW • OWNER/AGENT COPY
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