HomeMy WebLinkAboutPermit Septic Tank 1991-04-18/'kE-5ru.
REAUEST
FOR:SEPTIC SYSTEPi VERIFICATION
18 a7 05.900
1T3B
ADDBES9
SOUTI-i lLfin pLACE, spRINGi:IELD, 0REG0l'i 97478
srnucrunEs xow oN PBoPEa?YEXISTING SINGLE FAMiLY Dl,tELLINGI SHED
IIO. OF 4PLOYEES cotaaTBircTpil coaT/valuE
PRiVATE USE
DESCftPnON Of PEOPOqED WOBX
SEPTIC SYSTEM VERIFICATION
UBECTIONS TO 3ITE FIOT COURTHOUsE
FRANKLIN ELVD. TO SOUTH,,A,,, RIGHT O:.I SOUTH 52ITIO ST.I INTO JASPER ROAD,
SOUTH OI,I 34TA STREETI SECOND STRIET TO THE RIGHT
APPUCANT NAlrtE t ADDiESA
7 Ltl -7145D0L0RES l'ili\iS0R, SAI{E AS THE J0B ADDRESS A'c3\E
OWNENS NAUE I ADOBESS
SAME AS THE ABOVE SAME
CONTEACTOR NAME
ilA
O3N UCENSE
'it A
PHO}TE
NA
z-7/PERilTT #
I have carefully read BOTH sldes of thls
DOLORES I1III',ISOi?#zG:zLcertlfyall lnformatlon ls true and correct
READ CAREFULLYI Your Authorlzatlon !s Based On The Followl Condltlons
oerc / -/,f- 7tAPPBOVED BY:FEES DUE: 9
GALL FOR INSPECTTONS (SEE BACK OF FORM
SEPTIC permlts are good tor one year. ALL other permits expire after 180 days unless inspections are current.
lNsT RUCTIONS) 687-4065
iq.Q aEBw
I
T
T
TI
; -1. t.t t.t I t.:
hl : :!
AI}T}L I TANT bJ I N.SilR .
T[-{, I *0::(}6;i40S?0S
I :;l,lEtl EL-f fi TYI:,H:
fih,N[::R Nl'1ti 1.,]:N5'Utl,
ilr:ltrh ill"tll-. Ntl f:r[:T:t Ul'J I][:S'[:H ]:fiT I {li'{
Lrt
rr !"
l.r I
HP
IJ l-'
l"l [:. L, !"1
{rl tt'1
,.1. L.r i".
' r' t.. li-
i-_- r\
J.t-1''r.J -j?iLT'IITf' l.y',./ $f't I l"l
r,ir...*EkI{Nri: r-lLrLri"ll'Y ItIiii,J,'tr::i{T:}|jfi,],. ft[iIlilil'';lL-
"'ll' ,i]*,frt:fiIt,,,r:f;r:il|;:
stJfitt] l:y 1..il1'
LlsH H [riiftH,s * lJI.l:t15 ${.}t ,s'Ir}lI:IF-s ,tBL.Dr.iIr *i:i1 F'1.{fiNE 147
iltlt..r-!H[:S AI]liH 1{3:; S. .34T'H F[-,, S'I,HIHGF'1.[IL-P,
.t'
. r-.-_.
t-', rt 1
Li ii h:
..:i
i i 11
l.! lrl h. Lr Ll r.l
,.;{i f:'l' l.li,,lIl' {:tir;tT' Ur\l-.l.lr\T'l:ilN FEI:
i:i ii 'i {; , F'1.. N
-r. l' li:l I :
Trrlc.[:N IJY fil...i-l
t..i.: I I :l:Ji;ii :;'ilIju
,T'LI Ii : i:r l' " t{'i'Ii :
l"l[::fl{fttl ]: *'tl.- f i::fr
jj'i'di Iti.,$'UltIi-|fi Ill;[::
fiL-11N r-:t-iHUli l_'h-t:
f:T . Iirt i. F{ :rT
'] r{ ?'
./ s'l: uT f,t
ilf:riL].1I T' nr+
?5"00
a
I
I
r.,t I ^
IIL_H ' rl{:ti
{:{li{F'l-hT .t til{ $'qTH
'l' {'{:'
.L L) Li
-
f{: f'.1
v
T
J,
e
l
f
Sf/(
Exlstlng Bulldlngs or
lmprovements on
Property
B Housed B"rn
E3 Garage
E lr/ohile. Home
Ei{ str"o
SEPTICrzt Yes
INSTALLED
l-'l No
Water District
?7<2?
OWNER OF PROPERfY (il not *m. a3 rbova,
OWNERS AOORESS (il not lamc a3 abovc)
CONTBACTOH Liccn3c *
z
ztP
PHONE
ztP
Ui^l
whitePlease complete all lines inside boxes, if possible.
SoP,*
Directions to site
from
MAP, PARCEL NUMBER
led^M*H"-?k
Town3hip Rang. S.ction 1//t Slclion Ter Lot
T;iiifiii. 1ffiEt S;iEE- t7i5fii6i- -fs-it6i-
'>n*
For Moblle Home
Placement Only
No. ol Tip-outs-
No. ol Bedrms
License #-
Brand
Year
Size
Land Management Div. stalf can
not be held responsible for
evaluatlons or recommendations
based on false, lnaccurate or
lncomplete lnformatlon
SITE
1t-o>-aO 7{7eo
sl(-65"SIF65 GOMPOUiID-
brand ol
PEoPoxYPtlEllE lst
'trtr,7-/a
7// ( /
/:fi --i/
.-b-S--; >trPi
i,1
u,4t L-x
r>
:
t
h
n:!rl4H'>r -vtl .T, *.
.---r*''7 4
.:.