HomeMy WebLinkAboutEHPR-02-2017-25808.TIF ~0'. 3a
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` CATAWBA COUN'~Y'~ ~HEALTH DEPAR ENT
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Telephone: (704) 465-8270 TDD: (704) 465-8200
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Improve. Permit Author ization to Construct _Repair Permit~Oper. Per
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Owner/Agent ~-~~(',~/ ~ G~Lf~ ~JZ- JJ
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Address S Subdivision
C'~c,j ~ Section/Block/Phase Lot#
Lot
Size Directions: `3 L r-r- ~ ,$;~ D/L/
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Facility: House VP7obile Home Business Other: Tax Map #
Multi-family Other_ Zo~g Apprc 1 # ~
# Bedrooms_~ # Seats # Employees Applic\at~-on Rate GPD w
Hot Tub or Spa ye~Special Fixtures 1000 Repai Arr Arr ea yes/no
Basement yes/r~ Basement Plumbing yes/no \\\
Water Supply: Private Well Public
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Type of System: Trench Bed Pump Pump/Panel Panel LPP Other
Tank Size: Septic Tank Size a r[`XkS~/1./;.T Pump Tank Size
Nitrification Field: Total Square Feet Depth of Stone ~~'~ Bed Size ~~6 O~X~~s~
Trench Widt Total Length of 1 Trenches Number of Trenches
Individual Tren Length / / / eet on Cente Maximum ench Depth
Distance of Nearest e 1 *DO NOT INSTALL WHEN WET*
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Topo o Slope
Texture
Struct re
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Soi l Wetn s ~ _ - - - \~ - -~CN~L.~ ~ ~_
Soil ~ th ~ I a ~
Restri°~ Hoz . ~ \
Availabl~ ce yes/no~ ~
Overall Class S PS U ~ '~1 ~ ~ ~
Comments: ~ ~ ~'~ r' ~ ~
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**NO GUARANTEE OR WARRANTY IS IMPLIED OR G~VEN AS TO THE PERFORMANCE OR ENGTH 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 years from date issued and is not transferable.
Permit Date D(J~ ~3: ~99
Owner/Agent Sani~()'tarian ~.-
Installed By Date ~ ~Gy"-1 ~ Sanitarian
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White - Office Yellow -Owner/Agent