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HomeMy WebLinkAboutSAM-03-2020-130098.tifCATAWBA COUNTY HEALTH DEPARTMENT Telephone: (704) 465-8270 TDD: (704) 465-8200 Improve. Permit_Authorization to Construct_Repair Permit~Oper. Permit~System Type ~ Owner/Agent ~L~~(rv'.'~ ~Q,{~~.C~-2.- Phone Address Subdivision Section/B1Q.ck/P ase Lot# Lot She _ ~_~~ Dpi rectio~ ^ ~ z ~ L ~ ~ -~ $7 Q~i Facility: House_~( Mobile Home Business Other: Tax Map # Multi-family Other Zoning Approval # # Bedrooms~_ # Seats # Employees Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures 100% Repair Area yes/no Basement yes/no Basement Plumbing yes/no Water Supply: Private Well Public *********************************yy************************************************************** Type of System: Trench Bed 7(\ P,{u/-,mp Pump/Panel Panel LPP Other Tank Size: Septic Tank Size L }((S'f Pump Tank Siccze Nitrification Field: Total Square Feet Depth of Stone p< ~ Bed Size JC ~ ~ O Trench Width Total Length of All Trenches Number of Trenches Individual Trench Length / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well f;~(~~r *DO NOT INSTALL WHEN wET* *****,r**w********,t****v.*****************,r,r*v.*,r******,r,v***,r*************************v.*********** Topo o Slope Texture I Structure Clay Min. Soil Wetness Soil Depth Restric. Hoz. at " Available space yes/no~ Overall Class S PS U Comments : .~~, Ins i i ~~ 0 ,~ ~~~ ~y **NO GUARANTEE OR WARRANTY IS IMPLIED OR GyIyENC~S-TO T PERFORMANCE OR LE~GTH OF TIME THIS SYSTEM WILL FUNCTION** ~-lj~~C!/ J7~~Z~ t,r,r*rr,r*****,rw*,v********,r ~ww**,r*,***+.,r,r**,r*****,r *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 ©~ ~ 029 ~~ ~ ~ ~ A Owner/Agent Sanitari_`a~~~ Installed By ~1iL/ Date - ~"~( ~ Sanitary White - Office Yellow -Owner/Agent