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A35 194The District Health Department CASWELL - CHATHAM - LEE - PERSON COUNTIES .Water Supplyon�d�`Sewage Disposal IMPROVEMENTS PERMIT No. �� ��� , u� � U � � � ��. Date - . � Cj� ` - Owner: !_li 41 '� ��� : _ > +_4 � ,�� �1 Y � Location: '_ _ � \Z i �12 � Contractor: � r Water Supplp: ivate 4� lic � tt V I t � ./ Sewage Disposal Faciliiies: washing machine, other at Size of tank: 1 f�n � bedrooms �— Dishwasher, Disposal, atic appliances � ���itri8cation line: �ther disposal facility:: ,; Water supply and sewage disposal facilities location, installation and ; protection must meet state and local regulations. Septic tank should be pumped out every 3 to 5 years and shall be main- tained by owner in such a manner as not to create a public health hazard. - Septic tank and nitrification line MUST BE INSPECTED AND AP- PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT STAFF BEFORE ANY PORTION OF THE I STAL TION IS COV- ERED AND PUT INTO USE. _ . � Date approved: Signe '" Sanitarian Well: . Sewage Disposal: CounteT- � - ' By: signed (O r' repr se a e,� �ertificate of Comple2ion _ Date Approved: �� By: nitarian - (OVER) Location of well and sewage disposal facilities sketched on back. NOTE: �e sketch of installation showing lot size I— shape, location of house, septic tanks,III ies, water supplies, etc. Note special problems existing on lot. Wrate in measurements in order that installations !ll�be located at later date. Note location of water supplies on adjacent lots. � (1) ; ; , ��. . ,_ . - �, .��.... -3� J .I.� fi�� ��3� �. �� :�� �� �-- �.. »=�.:1 �: ' �i • �i . , � • • ;:-• .,1 ., ��r'�•' � � �: �4 3 5 . � �`��_ � ��IE�� �1� ����-a�,� � .�o.n�. - -�•► �': : I ,?� 1} PArR11t • �' ' ��Qd bY: ( ` odag4c�#/prosp�w ¢wn�r , �_ 1-Iome P6one: 3•. :�- � �. (� (o Ad�ress• , �. rr� S ` � BusUteas Phorte. �31�- �i7 -`253 F ��..`'- ��� �"� Z� o r` � �c:-, � . Nam� ar�d addresa af curret�t own�r. � e_�1 d S�-eu-P� � �. ,o��� . � . r --, p��7► DeaciiPtion: Laf size: ' Tawmship: ��0� ��!� P�'op�rty (lndudlR��p ad names and r� .. M (. ( L. - - - ^�. Lot v� �� ��Pas�t U�e and 3tn�cture Dascriprtllnn: a�swer each f the foiloyvin que�tions: �,. - a Pro w ) �SSd Exis$n9,�, Type of StTUCttlre:,�� n�>�-n �-�„�� c� ,� -, ;.� � W6dth; � pept�: y�:.. � b) Number �rF 9edrooms: -',� Numbar of occupants or people to ba served: �_ c) Baseme�� Ye,,�, Na ,.,�'y�ill there ba plumbing in th� base�ment? d) 6art�Se �ispcual: Yes . No,/ �) Water Su t . ' ' • ' PP�Y TYAe: Prlvate „�%(n� or �xls�ng;/ �•publlc,_, Cnmmunity . 3prfn9 — Are asty we4Js on adjo(ning ProPer{Y? YaBr. No ,_ If yas, pfeaae lndkk:ate a�praodmat� locatiari � the 'site plsn. 8) �o�s ynur proper�y cosialn proviousfy id�ed jurtsdlction8l wagfa�dST Yoa No� PLEASE NOTE THE Fp�LOWiNa� ' ' ' ' � . a• , _ • ... ', . ➢� A PLAT OF THE PROPEi21Y QR ST-i� pLqN 1iAUST BE SUBMRTED iNITH TH13 APPUC�110P1. . A PROPERl'1( L)NES AND CORNEFlS MUgT BE CLEARLY MARl�p. •, • ➢� THE PRQPOSED LpCAT10M OF ALL, STRUCIUR�B !I[I[UST BE STA�D OR FWGGED. �'iNE SiTE 1NUST BE READILYACCESSIBLE FOR AN EYALUATi�N BY 7HE•HEALTH DEPARTMENT STi�F. I hereby make application to tha Person CouMy Health Depariment fior a s�e evsluation fnr the oct-slia se�v�ge dlsp��! system for thQ a e-described proper{y, 1 agree that the conkenis of thfs applk�tlon are frue and represent the m�xdmurn �ilities to be p1 ��ths property. 1 understand if the sfte is a�teted ar the intendad use change�� tfie' p�rm#t sh�➢1 .:ome�lnvalid c�wnsr or Legal -��j Date PC1iD. tav. 6�27/02 /t Rpp[L699£C 4itoaH �eluawuo��nu3 •07 uoa�a,� wa ��:an cnnzincien �:�. )� �, � � . , . ���,d�! ��' � `�.�' � � 1.L �J3 i:Gr.,4.�i�.������.i�.�t��i�.�.�..� �9.. 1L�itt�.��� �ann��naa� �d�g�n�afl�/ PVg�d���ce �i��ae fl��������n��n�� Tax Map #:_�� Approval Requested for: Parcel#: g `T . ✓ 1V�obile Home Replacement Building Add.ition Applicant Name: c� S Address: - o G Phone #'s: r,C�Z - ,�, 2� �l7- ��3k Pernut Located: �/ Yes No Installation Date: ��� Desi� flow: 3�n (gpd) Current Contract with Certified Operator qn file (if required): ✓�5�r,�� Water �upply: Well Public or Community Wastewater system shows no visual evidence of failure on: _�-�-%/ (date) (Applicant's signature if site visit is not required) Comments: 7 � �v ��n�aoaa/�������a���� �g��a��de� S� �-�/ Envir ental Health Specialist Date 11/15/OS � �`� � r, �� �� � a � ` �-� � �,��� ,.. � � �` �� � � � � :_ ¢� ;: �F� � � ,.��� :h=�� � �� ' � � , VE".F �' =: �n ' �x9 i � ����,, � � � � �._ � ��. wti � �' � � � t %.�. �., q, .. . _ 09� �y '� � a� t .�. � ���'�; � . �-�, '� �Z�..��. � t '-.�. � ' �,ix r.; � ' �.�5" x°�`Di K. • $ ,�` .�.i,-. � ..�;' + T.: w� �� �A�� '����:% � .�.��t� . _ . .. ,�� - � t : �{�� � . � ,�• ; g� 24�`i5,� � � �� , x �r � � � � ���� 9 , � _� s �af ," `� � * ; � � �- ; � � �. 4 � �� � �, . � ` �: �� Y x. � ,,.; . '�' ;t � �� ;� � =.� �� �.� ,� � ,.,� � �� � � � � � � i, �� ,,,: � � : �. �� � � �. ,:� . � ,, -. < , �: � � .4 ,y �., �� �; ,� � ,� . � Q �� � � �. �. � .� . :. ,� � � � � _ � � � m�� -,�-° � ,� � : t �. .� '� ���..� � �.� ,�� � � � q� , `'� � ��.�� �� +fi '�"" � " �, i �� ty° � �'�'�� � •-� �' _ � �. � � � � �m"�''�, '�. T � ; r � f � � - � � 1�,� �'�' `� � e� �� s �' "�°i.'� e "k �`" S�: , �E - � � - ` ��. t T�� �� s � ''� �' r r � � < � �' " �^ts� ��s e � � d. . . ��a` : � �A � �, ="° r i � _ _ _ � <. �� _ � "� � � � ��� � -i �v 60 Feet � � r � � �� :�'�` ~� � �, . . ,—, . n pauxr�uimu si apa�u,S.ca�ou�j�� acnsut o,� uoa�»�rsuz ar�� �un�ua.�aq o�.sor.��usa�.r,fs arf� �vy�';snau ao�n.r�uoa ay,L •�uo s:tno�uoa:�tutxatqT�i�n �uasa,t�ac s�ruauo�jutqa tua�s�Gs a��Q �ua�� a�� S pazt�o�n _ � .� ��." #�orj�uoR�aS . i°TPqnS h � # Ia��ed � ��� � #_� d�L�I �Z � �' �� � ��� � �„ � �; � � �` ' '`' � a�N x�i�s ��s ����� �.����,��.���� �f ]1 � y �YJ� 11 � � �r r r t �� ��' . � �� ���� �� ��� . I 1 /, N01`E; ,�ice �keteti ot i�stm�ll�tion •:ehowing lot eize ., ��ha1�e, locatian oi housa, eeptic tanks� �� ..�vies. water aupp�iQs,.�t�. N�'.Ee speci�l problemA ex.[�a�in�,;on ;in�. �'P7r;9te`in measureri3en�s 9n orde� tha�t Inatallations �rnaY bE located