HomeMy WebLinkAboutEHPR-04-2021-37486.TIF
'.€ATAWBA COUNTY HEALTH DEPARTMEN.l1tSt/
. /' Telephone, (704) 465-8;;1-0 TDD, (704) 465-8200 N~ 0434
Improve. permit~uthorization to Construct~Repair Permit___Oper. PermitlC-System TYPe~
Owner/Agent ~ f- -;};~ Phone 'd.b(., - J-~
Address '! lr;-~ tL IV '......" Subdivision cV~ ' --0 A:..,pt-
Section/Block/P se Lot#
Facility: House Mobile Home_____ Business_____
Multi-family Other
# Bedrooms ~# Seats # Employees
Hot Tub or Spacres/no Special Fixtures
Basement yes/~ Basement Plumbing yes/no
Water Supply: Private Well_____ Public~
**........................................................*.........*..*...*.***.....~.,...~...
Type of System: Trenc~ed_____pump_____pump/panel_____panel_____LPP_____Other ~
Tank Sizs: Septic Tank Size /000 Pr~ Pump Tank Size /' /' r
Nitrification Field:/ Total Square Feet 90[) Depth of Stone ,#' :S-~~ze
Trench width _? , TO~1/ T.f~g.t~.:t All Trenche".-, ?Glq&~I>l~mber of Trenches J ".
Individual Trench Length~ll~ /~f____/____ Feet on Center ~ Maximum Trench DePt~ ~
Distance of Nearest Well A(~
................................................................................*..............
Topo -;-i~ Slope I
Texture -~~/ : \~' \<1
Structure S l<k/') I ttl
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"NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS
SYSTEM WILL FUNCTION"
Lot Size
1-..'
Clay Min, ;(
Soil Wetness
Soil Depth
Restric. Hoz. a
Available space
Overall Class S
Comments:
'\d~' ~'
lY"r;)S' ~. ),
d- ~'
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Other: Tax Map #
Zoning Approval #
Application Rate . )I
100% Repair Area ~no
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.............*......*..........*...............................................................
.Improvement Per.mit 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 date issued and is not transferable.
Permit Date
GPD Flow
*00 NOT INSTALL WHEN WET*
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Owner/Agent
Installed By
Sanitarian tf1'/lA ~ ~/r1!g
/1- 4 -qf,.. Sanitarian 1// /{. {A..{J.i~J.
Date
White - Office
Blue - Building Inspection Operation Permit . Y ~lIoW - Owner! Agent
Green - Building Inspection Authorization to Construct