HomeMy WebLinkAboutSeptic Repair 87 Woodland Drive r
TOWN OF SOUTH WI N DSOR �� 5_�" �
BUILDING DEPARTMENT
South r1ep)caCi
nnecticut
Application for Permit to Install oIndividual Sewage Disposal System
% Application N .
TO THE BUILDING DEPARTMENT: _ Date 19
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A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property 6Address of Owner 0 k204:�" die
2. Location of Property Lot. No. (o�-
3. Type of Structure `-' No. of Bedrooms_
(Dwelling,commercial)Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises �A/� &L Y n
5. Plumbing Fixtures: Water Closets 1�_ Urinals Lavatories Bathtubs�
Showers Kitchen Sinks Laundry Tubs .� Garbage Grinder -^ Other t&
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil G P—A-VtLlVlaximum ground water table b
TSan,,Grave,Clay,etc.
4
8. --If not served by public water supply: Distance from Owner's well �LJC fro�7,1a&, ,
' cent wells
9. Distance to nearest water course, drainage ditch, stor dr in r elalikment
10. Percolation Tests: Time for 1" drop in soil test ; Class cation of soil C
11. Minimum square feet of effective seepage area required /
12. Leaching System: Number of trenches ngth Wi, Total L
Other i (_V �I`
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Signature G'
(L e e ns ler)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By_: -z
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