HomeMy WebLinkAboutEHPR-4-11-10654 (2).TIF — ..- _ _ —_ __�
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C1�TAWSA COUNT�X. ,HEALTH DEPARTMENT
i ' (704) 465-8270
�Lot Eval. ✓Improve. PermitY'�Repair Permit Cert. of Comp. Permit_�Op�r. Pennit
Owner/Agent T�4��5 /�7. l,�dFFrnR� Phone
Address �� � �..�ts7'wAy o,P . Subdivision D.¢il G�Pr _v,j�
C . Section/Block/Phase Lot#�
Lot Size �D Directions: /Gl' �E'iG,tFr" /.r�78 a�� c� 54��.
iz � ' -
T4 �t � J i�.hs7� L d T' � // e nJ G r�T
Facility: House c�t4obile Home Business . Other: Zoning Approval es no �k?'��p,2
Multi-family Other . Tax Map # 98 �Il --1 -//
Bedrooms �_ Seats Employees . Application Rate� GPD Flow .�6Q
Hot Tub or Spa yes o Special Fixtures . 100� Repair Area es o REPAIItI�lOYICE;
Basement e no Basement Plumbing �no . RBPA�tS M1ST BS KITE�i 30 DAYS OR
flater Supp y: Private Public�/ . DAYS FROH DATE OF PERlQ'P.
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Typc of Syste�z Trench ✓Bed Pump Pump/Panel Panel LPP Other
Tank Sizes Septic Tank /� � Pump Tank
Nitrification Field: Total Square Feet d Depth of Stone la� Bed Size
Trench Width 3y" Total Length of All Trenches ��--� Number of Trenches "� --
Individual Trench Lengtt✓D�//ocy /o`�_/_ Feet on Center `� � Maximum Trench Depth a� �
Distance of Nearest Well 3�' Lot Evaluatione �gproved�eg�tio (Void After 24 aonths►
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� Topo /D � Slope � Sketch of lot Evalua on Site - System Desigr� - inal _
Texture G�iyy�,,lL � �gT',e e.�UUf�--� '�crw
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Structure l�c.or�� � k ==-z �._._�� 1 ��� � Q;y'
��cl'� � oAE +r� � ' ��
Clay M1n. / .'/ � � �_--_ — `�� � � _ _ .- � �"
Soil Wetness " � � � �,s
Soil Depth y� " � La�r �
Restric. Hoz. at SF1" �� �p , C. ,` �R� �
Available space es no�y �Q'�Q���k ��
Overall Class S � � " � \�
Comments : � I s-, `w ,
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Septic Tank Contractor i ti' ��y�p �����
MUST contact the �
Sanitarian BF�FORE � , �
changing permit. � ' i3y ____.___,_.
**NO GiJARANTEE IS IMPLIED GH THE ISSUANCE OF THIS PERMIT**
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Permit Date � �/f � (Improvement Permit void after 60 months)
Owner/Agent Sanitarian �-
Installed .d » Date l2-!.3 -9'� Sanitarian�• ��,n,,.�,
(Note any changes/information in red or by sketch on back)
�...w.wlY A PERI�T FWS TO BE RIDESIGNFD 111ID/OR REPRIPS l�ADE TO T[� PROPIItTY, Tf�REw:Rw*sww
IS l�lN ADDITIONAL $25 CfiARGF. �
White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp. I.P.