HomeMy WebLinkAboutT12N R3W SEC 13 Block 2 Lot 2 Lot No Longer Exists
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWAGE AND WATER FACILITIES
(['ill out in Triplicate)
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1711, /
Name of person requestzng approval ;HVI ,r.~-z
Numb~r-of~ed~ooms in house_~,-~<
Water Analysis:
b, Detergent
6. Well data:
a, Type
b. Depth ......
c. Casing Size
d, Distance from well to closest existing or proposed:
1. Sewer line
2. Septic tank
3, Seepage Area
4, Cesspool'
5. Property Line
6. Other sources of possible contamination, i,e,, creeks, lakes~
houses, barn, drainage ditch, etc.
Sewage disposal system.
a. Age of system
b. Septic tank capacity in gallons /q(~ ',r f,...
c. Name of septic tank manufsctu~$r
If "home made" show diagram on reverse side of this form.
Disposal field or seepa?e pit size and type
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1, Distance to property line ',+ to house foundation~