HomeMy WebLinkAboutSeptic Repair 969 Willow Street OWN OF SOUTH WINDSOR ��
BUILDING DEPARTMENT g�
South Windsor, Connecticut `0. 3 �( C
Application for Permit to Install or Repair Individual Sewage Disposal System
Applicati N/+o.
TO THE BUILDING DEPARTMENT: Date rtz t ( 19 F
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information ijsubb itted:�K,Jl�{ ,¢ /
1. Owner of Propert ess of Owner 9(3 &14tu ) r
2. Location of Property Lot. No.
3. Type of Structure ! L-'(_L No. of Bedrooms
�j - (Dwelling,Commercial/Building,Store,etc.)
4. Number of Families or Persons to Occ y Premises /� L
5. Plumbing fixtures: Water Closets Urinals ' Lavatories Bathtubs_
Showers Kitchen Sinks Lptindry Tubs Garbage Grinder Other.
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
( an ,Gravel, 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 a. or embankment
10. Percolation Tests: Time for 1" drop in soil test lassification of soil �( `
11. Minimum square feet of effective seepage area required r1 / ♦ o
12. Leach ilt ystem: N be of tr hes Length. G�' Width_49 X J— Total �s 0
Other
Signatur C%
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
a
b(
30�
1 C L�C—fl tole ��
ermft Issued 19 By
Installation Completed, Inspected and Approved 19 By,