HomeMy WebLinkAboutSeptic Repair 192 Oak Street TOWN OF SOUTH WI N DSOR
f BUILDING DEPARTMENT
South Wi Connecticut
Application for Permit to Install o Repair Individual Sewage Disposal System ]
Application No.
TO THE BUILDING DEPARTMENT: Date CtL �_19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: 9
1. Owner of Property �� �ol� Address of Owner / l a)
2. Location of Property Lot. No. SO
3. Type of Structure_ x/[a No. of Bedrooms
(Dwelling,Comm?!/,C/
ial Building,Store,etc.) (�
4. Number of Families or Persons to Occupy Premises Cu — 54&l L /
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks / �rldry Tubs " Garbage Grinder~_ Other_
6. Liquid Capacity of Septic Tank ? (,s lr r� Material of Septic Tank �1
7. Soil Conditions: Type of Soil��/ .��cq,� Maximum ground water table_ C-
San r sell, ay,etc.) /
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, sto m d ain or embankment L�
10. Percolation Tests: Time for 1" drop in soil test Clessi$cation of soil
11. Minimum square feet of effective seepage area required f�
f� •
12. Leaching System: Number of trenches Length
/ C S� , Widt Total G31/tGL�
Other !f G�� ��v h MA&4A
� 4
Signature
j cense Installer)
(Sketo showing all minimum distances and other details required halo )
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By