HomeMy WebLinkAboutEHPR-12-11-13584.TIF..:. . ~
~i'~ N_ 02798
C A T AW B A C O U N T Y H E A L T H D E P A R T M E N T
(704) 465-8270 ~/
Lot Eval. Improve. Permit /~ Repair Permit Cert. of Comp. Permit A Oper. Permit
Owner/Agent ~/ ~~ ~ G~~~~v Phone 7~
Address Subdivision
Sefj,~on/Blo k Lot# '~
Lot Size Directions: ~. ~Q~r `~6 ,~i
Facility: House Mobile Home Business Other: Zoning Approval es no # ~ ~
Multi-family Other 100% Repair Area yes/no
Bedrooms ~ Seats Employees GPD Flow ~3 %.0 Application Rate ~~
Hot Tub or Spa yes/~ Special Fixtures REPAIR NOTICE: REPAIRS MUST BE WITHIN
Basement yes/fro Basement Plumbing yes/no 30 DAYS OR DAYS FROM DATE OF
Water Supply: Private Public PERMIT.
Type of System: Trench~Bed Pump Pump/Panel Panel LPP
Other
Tank Size: Septic Tank / ~~ Pump Tank
i/
Nitrification Field: Total Square Feet aG Depth of Stone ~~ Bed Size
Trench Width ~ ~~~ Total Length of All Trenches ~~~ p Number of Trenches ..3
Individual Trench Length~~/ ~~/1 ~~/_/_ Feet on Center 7 / Maximum Trench Depth ~a ,~
Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months)
Topo % Slope ~
Texture ~
Structure
Clay Min.
Soil Wetness "
Soil Depth "
Restric. Hoz. at _"
Available space yes/no
Overall Class S PS U
Comments:
r
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT**
Permit Date Z ~ 4/ (Improvemen rm' /void/ a/ ter 60 months)
Owner/Agen ! G!-~~-~ S itarian V ,
Installed By ~° Date 3 Z z Sanitari
(Note any changes/information inured or by sketch o back
Sketch of lot Evaluation Site= Svst~ De,Sign_~'inal„,„
~ ~