HomeMy WebLinkAboutSEP1972-00199 ' 903 Caroline CL EPIC HEALTH DISTRICT Perstit No, !j� l
'-ar `-Angeles Fee Paid- / ; .
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SEWAGE DISPOSAL PERMIT APPLICATION
�%' Submit in Duplicate i ,�
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LEGAL DESCRIPTION r). / �-e C '�'� PHON
DIRECTIONS FOR LOCATING SITE _. c,W t -- '� c'' C' . `'` `L ` ' ` �'°
APPLICATION IS HEREBY MADE TO: INSTALL NEW SYSTEM' *AIR EXISTING SYSTEM
\i A c:_. t'l.,r
'YPE OF BUILDING NO. ` �
� OF BEDROOMS BASEMENT SITE SITE NAME OF INSTALLER
ON THE-REVIRSE-SIDE, DRAW A DETAILED PLOT PLAN GIVING THE FOLLOWING INFORMATIi l/
1. Property lines 7. Driveways, patios, carport, etc.
2. Location of building 8. Streams or bodies of water nearby
33.__Location of septic tank 9. Location of percolation test holes
4.._Location of drainfield 10. Septic tank size 'C' Bailor
5.--Slope of land 11. Length of proposed drainfield
6-. _Water lines & well(if applicable) 12. Depth to water if encountered.
PERCOLATION TEST RESULTS.
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Depth Time required to * Percolation rate Type of soil
of hole ' seep last 6 in. (divide time by 6)
Pert. No. 1 . ..5-\.\, .
Pert. No. 2
Pert. No. 3. [ �._... -pc,:
DRAINFIELD LENGTH "leo WIDTH DEPTH ' NO. OF LINES `"'' 3 �` C'
IT IS HEREBY AGREED THAT THE PROPOSED INSTALLATION WILL BE MADE IN THE MANNER
AS-DESIGNED AND APPROVED ON THIS APPLICATION. A
Signature of Applicant
APPROX. DATE OF INSTALLATION
SANITARIAN'S COMMENTS: .; - ,.w pl,"`\ vvy 1/4-1,■,`c "1917 t--
—THIS_CONSTITUTES A PERMIT WHEN HEALTH OFFICER'S SIGNATURE APPEARS AS APPROVEL 3
PLAN _APPROVED s,a 1/4--- -.-W-° 7 DISAPPROVED DATE { i / L N
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DATE_ INSPECTED, `: ...�, _.. "`:,
v . ert.0 v` \u c �> � SANITARIAN
REMARKS: ` j `��y�` c ,, ,�. .. .�"'
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I CERTIFY THAT T %, , T. ��1. I�ALLED IN THE M��NNER APPROVED BY TALE 1i -Li
DEPARTMENT. °" �' 4.,. ...�z.. -.,-
Il 'ALLER T S NAME r DnT