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CITY OF INDEPENDENCE-*
WORKSHEET FOR SEWAGE DISPOSAL WORK
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Date — 2 2"/e
Building Permit No. 7_0c>`! " e) C_"
Owner r.C} W -c t-,�3 % (– 6CJd 1-11"141 Fee
Property Address -110 of Kind of Building
Plumbing Contractor -Outside Sewage Disposal i' A `1 �a d"`;�`�
Septic Tanks 9
Material �'- n'��
(OAVWQ� Capacities 1
Proper Outlet & Inlet? `' Baffle Plates?
Drain Field: 1
Total length of lines; Number of lines
Type of soil 15 ��� Percolation Test " �s
Width of trench Type of filter material
Amount of filter material below lined
Depth from top of tile to finished grade
Check Vents v� Check Caulking
Check Grade in Horizontal Waste Pipes Clean Outs
Tonage or Yards of Filter Material 'g 5 `9 5 Total Sq. Footage of Drain Field
Sand 2- X i Rock
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