HomeMy WebLinkAboutIMPV-1-10-4340.TIF
CDP File Number 38406 County ID Number; EHPR-1-10 3389
"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 by the Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
The Improvement Permit shall be valid for 5 years from date of issue with a site plan (means a drawing not necessarily drawn to
Site Plan scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the
G site for the proposed wastewater system, and the location of water supplies and surface waters).
Plat The Improvement Permit shall be valid without expiration with plat (means a property surveyed prepared by a registered land
surveyor, drawn to a scale of one inch equals no more than GO feet, that includes: the specific location of the proposed facility
0 and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters. Plat
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 plat that 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? /OYes ONO
ApplicantlLegal Reps. Signature L Date: / t / 46,
'Issued By: 1919- Susan Miller Date of Issue: 1 / a 8 / a 0 1 0
Authorized State Agent: -Z"P' OValid without Expiration?
OHand Drawing Glmport Drawing
**Site Plan/Drawing attached.** Total Time:(1-11-11MA)
0 0 Hours 0 0 Minutes
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