HomeMy WebLinkAboutEHPR-1-12-14115.TIF
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~ATA WBA COUNTY HEALTH .DEPARTMENT _
-:elephone, (704) 46S-SpO ,TDD' ~704) 465-S200 . V N~ ~O 4 9 3 ~
Improve. permit~thor~zatlon to con6truct~Repalr Permlt___Oper. Permlt~SY6tem Typ ~
. ~
~-;: ~. . ' Phone ?o (/_ 3?6 - 9/r'o Cl
~ fri OI!..MJ9A) 1)121 (/~ Subdivision rPiJ/AIrF /1/0.em/M.I \
- I2..t? - C Section/BlockLPhas'il I Lot# /6
~ Directions:
Owner/Agent
Address
Lot Size
4
Facility: House Mobile Home_____ Business_____
Multi-family Other
# Bedrooms ~# Seats # Employees
Hot Tub or Spa ye~ Special Fixtures .
Basement yes/~ Basement Plumbing-yes~
Water Supply: Private Well_____ Public~
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Other: Tax Map #
Zoning Approval # Z .,
Application Rat~
100% Repair Are yes 0
o
GPD Flow
3t.O
Type of System: Trench---LLtled_pump_Pump/panel_panel_LPP_Other
Tank Size: Septic Tank Size /000
Nitrification Field: Total Square Feet 9 () n
Pump Tank Size
Depth of Stone
J;:) /I
Bed Size
,1 r Total Length of All Trenches
Length~/~/60/~/1ilL Feet
<300
Number of Trenches
o I ,
/ Max~mum Trench
-s-
Depth ~$t I
Trench Width
Individual Trench
on Center
Distance of Nearest Well
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'DO NOT INSTALL WHEN WET.
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Topo t::, % Slope
Texture r..Lf1Y~1
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Structure ;3tA'),cRy I
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Clay Min. /) / I
Soil Wetness II I
Soil Depth j/.).. "I
Restric. Hoz. at~. I
Available space enol
Overall Class S I
Comments: I
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**NO GUARANTEE OR WARRANTY I
SYSTEM WILL FUNCTION"
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~ ~IVEN AS
IMPLIED
LENGTH OF TIME THIS
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.Improvement Permit has no expiration date and is trans~erable, but may be revoked if site
plans or intended use changes for the proposed facility. An Authorization to Construct is
valid for (5) five y~~ ~rom date issued and is not transferable.
Permit Date {)PA-<e:...."/D J99C
(\' . -
Owner/Agent mWWM lO. ~
Installed By (\tV'4 Jnr)rnlfo
, . S~nitarian C_ ~ . == ~,<::"
D.ate ?'3~,)? Sanitarian -~; f'.. .
." ..., , . tPVI... :........... . ..-.....-". O. k _
Yellow - Ownerl Agent Green - BullJ'ing Inspechon Authonzation to Construct
White - Office
Blue - Building Inspection Operation Permit