HomeMy WebLinkAboutPermit Plumbing 1976-2-27
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~~ .t'sEWAGE DISpcOSAL SITE EVALUATION
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Job Locallon
Written Directions
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'APPLlCft:NT'S NAME AND ADDRES~ ,'r'l II' I '-::'A 1\ >:
OWNER'S NAME AND ADDRF'"'' ~ r I L L,-" I, f;:..r,.. I"'"L h' I. 1 ~' ,
STRUCTURES NOW ON THE PROPERTY ~ 'C r L t:: If i= I 1'_ ;-
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WATER SUPPLY
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PROPOSED USE OF PROPERTY
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I hereby certify that the above st~tements are true and accurate. and that I have the following legallOterest In the property --owner of record. -contract purchaser r'\'Jtentlal bUYt;:,.
-X-realtor or agent I further<certlfy that ~lf not the owner) I am authorized to act for the owner of record a;,~_~fJ( ,said o~neUs ~w~ e Brtd app.tr)o I s of this action
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* * * ... ... ... ... * * * * * * * * .. * * .. .. * * .. * * * * * * * * * * OFFICE USE ONLY BELOw....THIS LINE * .. * * .. * * * * .. * * * * .. * * * .. .. * * .. * * * * .. *.
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THIS REPORT IS NOT A PERMIT FOR SEWAGE SYSTEM INSTAllATION
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described on the attached plot plan
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If thiS -report approves use of a sand filter or pressurized
.; , Will be reqUired With the installation permit application
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distribution system, detailed construction deSign plans
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WARNING:
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THIS IS A PRELIMINARY REPORT WHICi!i DOES NOT
ENSURE- THE ISSUANCE OF A FUTURE BUILDING
PERMIT ANY PLANS OR EXPENDITURES MADE IN
RELIANCE UPON THIS REPORT ARE AT YOUR OWN
RISK IF SITE IS APPROVED, SEE REVERSE SIDE
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DEO AUTHORIZED AGENT
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ThiS Site Evaluation IS a technical report to determine If a on-site
system Will function properly It does not approve the proposed use of
the parcel ThiS Site Evaluation may be converted to a construction
permIt only If the parcel and use meet land use regulations In effectet
the time of application YOU ARE URGED TO CONTACT YOUR LOCAL
PLANNING OFFICE FOR LAND USE REVIEW
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