HomeMy WebLinkAboutEHPR-04-2012-15573.TIFt ~`• ~ ;` ~~~ N° 3075
C A T A W B A C O U N T Y H E A L T H ~E P A R T M E N T
(704) 465-8270
Lot Eval. Improve. Permit Repair Permit~Cert. of Comp. Permit Oper. Permit
Owner/Agent
Address
Lot Size
Directions:
Phone 3c~~- ~ Q ~ ~
Subdivision
Sfecti~~/o/n~/Block ~~rr Lot#
Facility: House Mobile Home Business Other: Zoning Approval yes/no #
Multi-family- Other 100% Repair Area yes/no
Bedrooms Seats Employees GPD Flow Application Rate
Hot Tub or Spa yes/no Special Fixtures REPAIR NOTICE: REPAIRS NUST BE MITHIN
Basement yes/no Basement Plumbing yes/no 30 DAYS OR DAYS FROM DATE OF
Mater Supply: Private Public PERl~QT.
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Type of System: Trench Bed Pump Pump/Panel Panel LPP
Other
Tank Size: Septic Tank Pump Tank
Nitrification Field: Total Square Feet ~g(;)n, Depth of Stone~~~ Bed Size lU
Trench Width Total Length of All Trenches Number of Trenches
Individual Trench Length-/_/_/_/_ Feet on Center Maximum Trench Depth
Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months)
Topo % Slope ~ Sketch of lot Evaluation Site - System Design - Final
Texture ~
Structure ~
Clay Min. ~
Soil Wetness ~
Soil Depth ~
Restric. Hoz. at _" ~
Available space yes/no)
Overall Class S PS U ~
Comments: ~
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**NO GUARANTEE OR WARRANTY IS IiiPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERPiIT**
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Permit Date y l~'- ~! (Improvement Permit vo a ter 60 months)
OFmer/Agent ~ - Sanitarian ~-S,
alled By ,~,(, ~~rr Date~~!'l~ Sanitaria ~4
(Note any changes/information,;_in=L Rd or by sketch on ack)
WY.~ite-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp.I.P.