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Improvement Permit
A building permit cannot be issued with only an Improvement Permit
PROPERTY LOCATION: 1 i 2 5
ISSUED TO: 4 SUBDIVISION ORC a ii-c') LOT #
NEW K REPAIR ❑ EXPANSION ❑ Site Improvements required prior to Construction Authorization Issuance:
Type of Structure: t~,5 x 2 - j 13(t-
Proposed Wastewater System Type: Z i 1,
Projected Daily Flow: 3toD GPD
Number of bedrooms: 3 Number of Occupants: Cr max
Basement ❑Yes *1 No
Pump Required: ❑Yes ❑ No T;tMay be required based on final location and elevations of facilities
Type of Water Supply. ❑ Community fid Public ❑ Well Distance from well SJ feet Permit valid for. ~Tive years
Permit conditions: S7tu 2~ ,per} C~l~, r,4, ~
0-
❑ No expiration
Icti.r
Authorized State Agent: Date: - 3 - 0 TS SEE ATTACHED SITE SKETCH
The issuance of this pernk by the earth Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting
their requirements. This site is subject to revocation if the site plan, plat, or the intended use changes. The Improvement Permit shall not be affected by a change in ownership of the site. This
permit is subject to compliance with the provisions of the laws and Rules for Sewage Treatment and Disposal and to conditions of this permit.
Construction Authorization
(Required for Building Permit)
The construction and installation requirements of Rules .19S0, AM, .1954, .195S, 1956, .1951, .1956. and .1959 are incorporated by references into this permit and shall be met. Systems shall be
installed in accordance with the attached system layout.
ISSUED TO: PROPERTY LOCATION:
SUBDIVISION F~tZc) 7 as k S LOT # } g~
facility Type: S F0 - ~9 x S2 `'10(i .New ❑ Expansion ❑ Repair
Basement? ❑ Yes ' No Basement Fixtures? ❑ Yes R' No
Type of Wastewater System" ,25--f- 6,, . (Initial) Wastewater Flow- GPD
(See note below, if applicable)
(Repair)
ImWkbouR quiremeConditiau
Septic Tank Size ()00- gallons
Pump Tank Size gallons
Pump Requirements: ft. TDH vs.
Conditions:
Exact length of each trench IX as 1 feet
Trenches shall be installed on contour at a
Maximum Trench Depth of: _ I ~ inches
(Trench bottoms shall be level to +/-1/4"
in all directions)
GPM
Trench Spacing: Feet on Center
Soil Cover. inches
(Maximum soil cover shall not exceed
36" above the trench bottom)
inches below pipe
Aggregate Depth: inches above pipe
inches total
applicable l undeatand the fyitem type specified is dih`emot from the type specited on the application. l accept the specilcations of this permit.
Owner/Legal Representative Signature: Date:
This Construction Authorization is subject to revocation (the site plan, plat or the intended use changes. The Construction Authorization shall not be transferred when there is a change in ownership
of the site. This Construction Authorization is subject to compliance with the provisions of the laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit
Authorized State Agent. a- ~ Date: SEE ATTACHED SITE SUM
Construction Authorization Expiration Date:
I {_y
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Permit # (a -
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Site S kctc°h
PROPERTY LOCATON:
ISSUED T0: - Can SUBDIVISION F-~ 2 c 7 92
S LOT #
Authorized State Agent: G'- Date:
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