HomeMy WebLinkAboutEHPR-02-2015-20841.TIF~:3~
~~ ~ CATAWBA COUNTY 'HEALT~I DEPARTMENT
Telephone: (704) 465-8270 TDD:- (7 ) 465-8200
Improve. Permit Authorization to Construct_Repair Permit~~per. Permi System Type
Owner/Agent ~/Ir~~da ~VA l~Q~ Phone o~~y- 07~~~
Address ~~ (-p~{~-may D~ Subdivision
y JJ~ ~ SectioA/ ~-oc~s~~/ot#
Lot Size Directions : / Z ~ S ~~/a-~~GLL/Ih~~ r* ~ ~..o
Facility: House_~ Mobile Home Business Other: Tax Map # ~
Multi-family Other Zoning Approval #
# Bedrooms~# Seats # Employees Application Rate GPD Flow
Hot Tub or Sp yes/no Special Fixtures 100% Repair Area~e no
Basement yes/no Basement Plumbing yes/no
Water Supply: Private Well Public
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Type of System: Trench Bed_ ~ P,ump_ Pump/Panel Panel LPP Other
Tank Size: Septic Tank Size C",~/S77/~/~ Pump Tank Size
Nitrification Field: Total Square Feet ~~ Depth of Stone / Z. Bed Size l~ X
Trench Width Total Length of All Trenches Number of Trenches
Individual Trench Length / / / / Feet on Center Maximum Trench Depth
Distance of Nearest Well
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Topo ?~o Slope
Texture Gl/~~~
Structure ~GLL~G/ ~
Clay Min. /
Soil Wetness ~S'
Soil Depth 7~i~--
Restric . Hoz . at'-"""'~
Available spacno~
Overall Class U
Comments:
*DO NOT INSTALL WHEN WET*
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**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS
SYSTEM WILL FUNCTION**
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*Improvement Permit has no expiration date and is transferable, but may be revoked if site
plans or intended use changes for the proposed facility. An Authorization to Construct is
valid for (5) five ears from date issued and is not transferable.
Permit Date ...5 Z Z
Owner/Agent, ,~ ^ Sanitarian
~/ ~~ ~
Installed By ~ Date - Z ' !~ Sanitar' n
White - Office Yellow -Owner/Agent