HomeMy WebLinkAboutEHPR-05-2018-29099.TIF1' - ~ ~
CATAWBA C®UNT~ HEALTH
Telephone: (704) 465-8270 TDD: (704)
Improve. Permit Authorization to Construct~epair Permit_
Owner/Agent
Address i/i
Lot Sizr~a ®5.5bscir,.wapirect
b5~
DEPA _ MENT
465-8200 u ~ 2 ~ ~ ' j~j/)
Oper. PermitSystem Type
Phone (~
Subdivision
Section/Block/)yha
/~ ~06
Facility: House !/ Mobile Home Business Other: Tax Map # / / F- ~- - '-.S ~1
Multi-family her Zoning Approval # O,S 7
# Bedrooms~# Seats # Employees Application Rate ~ S GPD Flow
Hot Tub or Spa yes/no Special Fixtures 1000 Repair Area e 'no
Basement yes/~ Basement Plumbing yes/no
Water Supply: Private Well Public_l~
vw*,r****,rvr*,r,r*,r**,r*v.****,t**** *,r*,rw**,r,r**,r***,r,-*,r**,r,r**,r,r***,t*,r,t,r,t**,r****,t,t,r,t,t,t,t,t*,t,t,t**~r,r+k*,t*,r*
Type of System: Trench y, Bed Pump Pump/Panel Panel LPP Other
Tank Size: Septic Tank^Size Qd(7 Pump Tank Size
Nitrification Field: Total Square Feet ~ Depth of Stone `~ !` Bed Size
Trench Width Total Lerngth of All Trenches ~ Number of Trenches
Individual Trench Length `,S/ ~~j / ~~~/~/ Feet on Center Maximum Trench Depth~~~
Distance of Nearest Well *DO NOT INSTALL WHEN WET*
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Topo ~- Slope
Texture ~ ~..`3 I
Structure ~ ~ ~D~
-~~~ ~
Clay Min. ~r/ '' ~ fvQ~ ~~ ~ '_ /~ ~ ~1 r°d~
Soil Wetness I ® 1
Soil Depth ~ rn„ ~-~t ~( ~/~J~ ~~ ~' ~ Y~
Restric . Hoz . at 0 ~ 1~'~/ ~ /~"~ 1 r,
Available space /nol ~ ~ ~! . f~~
Overall Class S U I ~~
Comments: I
~~ ~~
og ~
o~
**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH 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 ea from date issued and is not transferable.
Permit Date
Owner/Agent Sani arian ~ t~ vj~
Installed By Date'-~,~~ Sanitarian
White - Office Blue -Building Inspection Operation Permit Yellow -Owner/Agent Green -Building Inspection Authorization to Construct