HomeMy WebLinkAboutRBPR-09-2020-35576.tif
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C'ATAWBA COUNTY HEALTH DEPARTMENT
Telephone: (704) 465-8270 TDD: (704) 465-8200
Improve. permit~thorization to Construct___Repair Permit___Oper. Permit~System Type
Owner/Agent CRp~ k'e:s:Ot.fR.f::.C-::5 .r-He. Phone ,06~-:S -b''7()..5""
Address .fJ () f'Z,nx ./l)1J. ~./ Subdivision .L,4~f; PtJIA~ AlOtz:r):)
t"~"-/)I /('--:: /1/.C -4J"('J{)( Section/Block/Phase J . Lot# ~t1~A
L~:ef!i~i~t;,~ ~~~;:j~{~~,T~1J9Nb ~)~m:- ~
Facility: House~ Mobile Home_____ Business_____ . Other: Tax Map #
Multi-family Other Zoning Approval #
# Bedrooms -V- # Seats # Employees Application Rate I ~~ GPD Flow ~
Hot Tub or Spa yes@pecial Fixtures 100% Repair Area~~o
Basement~9ino Basement Plumbing ye~
Water SuPPi),: Private Well~ublic ..J<:::~ p ,,~)...S""~
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Type of System: Trench_____Bed_____Pump~~ump/panel_____Panel_____LPP_____Other ~{~)~~
Tank Size: Septic Tank Size
Nitrification Field: Total Square Feet
Pump Tank Size
Depth of Stone
Bed Size
Trench Width
Total Length of All Trenches
Number of Trenches
Individual Trench Length____/____/____/
/
Feet on Center
Maximum Trench Depth_____
Distance of Nearest Well
/DD1+
*DO NOT INSTALL WHEN WET*
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**NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS
SYSTEM WILL FUNCTION**
Clay Min. I :)
Soil Wetness
Soil Depth 9=:2...
Restric. Hoz. at
Available space
Overall Class
Comments:
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*Improvement Permit has no expiration date and is transferable, but may be
plans or intended use changes for the proposed facility. An Authorization
valid for (5) fiv years from date issued and is not transferable.
Permit Date
owne~'ilb
Inst~y
revoked if site
to Construct is
Date
Sanitarian ~ ~ ~---,es.
Sanitarian
White - Office
Yellow - Owner! Agent