HomeMy WebLinkAboutEXSY-3-11-16049.TIF $_ � -3 -t1- I Lo
• C ATAWBA COUNTY Case # PR'3'II - 9'15$
/ t ER Public Health Department Subdivision
t ,a Environmental Health Division SectionBl/Ph/Lot#
PO Box 389, 100A Southwest Blvd, Newton NC 28658 P>N# 37 C) 1 VQ
8 , (828) 465 -8270 Fax (828) 465 -8276 TDD (828) 465 -8200
Applicant/Owner 11',.40{ N rIF
Site Address: O Oy4 Savo I led La. ►bti
Property Size: ai, 7
Directions:
EXISTING SYSTEM INSPECTION REPORT
Site /Svatpm nisuiram
iq *Sec VI 1\6.9 o tyty wla' 0030?
—I
aLp
1` _
zs
3Srdmrne,
r , .
Oxywd Sjoal R.d /90. 41'
C1,0
ype of Facility : House ❑ Mobile Home 12 #Bedrooms _Ai_
Business ri Specify
Other f 1 Specify I -_
roposed Additions/Accessory Structure: a �'� )�- 01(0 • �7ati Sva U , igh; / i
.pproved ri Not Approved ❑
Reason
vidence of System Malfunction : YES ❑ NO V Sysem Type/Description m -vii fO
4 iiTiJJ & 4111,Wiftnikfr ,3
AUTHORIZED &TATE AGENT APPROVAL DATE
NOT FOR LOAN APPROVAL