HomeMy WebLinkAboutIMPV-1-10-4371.TIF
CDP File Number 38435 County ID Number: EHPR-1-10-3413
Site Modifications ❑ Open Fill Sheet
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department-
"Permit Conditions
The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
Site Plan The improvement Permit shag be valid for 5years from dateof issue with a site plan (means a drawing not necessarily drawn to
O scale that shows the existing and proposed property lines with dimensions, the location at the facility and appurtenances, the
site torthe proposed Wastewater system, and the location of water supplies and surface waters).
Plat The Improvement Permit shag be valid without expiration with plat (means a property surveyed prepared by a registered land
surveyor, drawn to a scale atone Inch equals no more than 60 feet, that includes: the specific location of the proposed facility
and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters. Plat
O
also means, for subdivision lots approved by the local planning authority and recorded with the county register of deeds, a copy
of the recorded subdivisions platthat is accompanied by a site plan that is drawn to scale).
The Department and Local Health Department may impose conditions on the issuance and may revoke the permits for failure of
the system to satisfy the conditions, the rules, or this article This permit is subject to revocation if the site plan, plat, or intended
use changes (NCGS 13OA335(f)). The person owning or controlling the system shall be responsible for assuring compliance
with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring,
reporting, and repair (1938(b)}
Applicant/Legal Reps. Signature Required? OY S ONO
Applicant/Legal Reps. Signature Date: a7
'Issued By: 1952 -Phelps, Robert Date of Issue: 0 1 a 9 a 0 1 0
Authorized State Agent: I A'- OValid without Expiration?
OHand Drawing Olmport Drawing
**Site Plan/Drawing attached.** Total Time:(HH:r.M)
0 Hours 1.1 mutes
Page 2 of 3