HomeMy WebLinkAboutEHPR-01-2021-36577.TIFC A T A W B A C O U N T Y H E A L T H
(704) 4~b5-8270
Lot Eval. Improve. Permit Repair Permit ~ Cert. of
n'EP~ E°NT3131
Comp. Permit Oper. Permit
Phone ~lo- 7Q ( ~/
Subdivision
Section/Block Lot#
Facility: House Mobile Home Business Other: Zoning Approval yes/no #
Multi-family- ther 100% Repair Area yes/no
Bedrooms Seats Employees GPD Flow Application Rate
Hot Tub or Spa yes/no Special Fixtures REPAIR NOTICE: REPAIRS MUST BE WITHIN
Basement yes/no Basement Plumbing yes/no 30 DAYS OR DAYS FROM DATE OF
Water Supply: Private Public PERMIT.
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Type of System: Trench Bed X Pump Pump/Panel Panel LPP Other
Tank Size: Septic Tank Pump Tank
Nitrification Field: Total Square Feet_ Depth of Stone~_ Bed Size )C
Trench Width Total Length of All Trenches Number of Trenches
Individual Trench Length-/_/_/_/_ Feet on Center Maximum Trench Depth
Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months)
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Topo °s Slope ~ Sketch of lot Evaluation Site - System Design - Final
Texture ~
Structure ~
Clay Min. ~
Soil Wetness ~
Soil Depth ~
Restric. Hoz. at _" ~
Available space yes/nod
Overall Class S PS U ~
Comments: ~
**NO GUARANTEE OR WARRANTY IS IliPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT**
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Permit Date ~- l - `~ (Improvem nt Permit void t 60 months)
Owner Agent Sanitaria ~ ~~~,
alled By ,v(,~ / Date G~-/Y-G/ Sani r ~.5.
(Note any changes/information in red or by sketch on back)
WT.~ite-Office Blue-Bldg. Insp. Comp.. Yellow-Owner/Agent Green-Bldg. Insp.I.P.
Owner/Agent ~(i j ~2~N (L>rese-'~-2
Address 2~ ~ ~ti- `/r2 /~~L./