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A36 35
r�yl�ii�'rluuu uate: �`3'i�� - . ��:- �. nt PaYd: oZ00. DO Receipt#: _ �' '�� ( � � ��� � ���� �� ���� ry�� -� � " --- �r� � 1r.��Cr�r° ��- , J.C�:,�v71'�f.'4�'�l]L �[:Y.ILT_JC7YT.C'?J�T.'�..¢p..Il. �E.11.�.c_�xR.Il:U::.ILT. � �PPlic��ion %fl• Servic�s � � (Septic Svstems and Wellsl SeBwices L Improvement �ermit (Site Evaluation) $200.00/$300.00 (if % 600 gpd) G Mobile Home Replacement or �uilding Addition $I�0.00 (ifsite visit reauiredl � ❑ Well Perre�it (rlew/Iteplacement) $225.00/$125.00 L' n �� Tax Map: � y 7 Parcel #: � Constrnction Autl�orization 'Fee is dependent on the type of sy� Permit gievision $75.00 Repair �f Existing Septic u�ystem No Charee Important: If t/�e infvrrnntforr i�e t/ie app[ication for an Lnproven:er:�Perutlt is bicorrect, fnlsifie�l, or� tfie site is nitered, Pher� 1/ee I�s2pruve�ne�i! Pern:rl a�id i/te Atat/torizrrtion to Cnrisiruct shall becnine invalitl. �) 5ervic�es I�e tie�#ed b�: , ' . . Name: � ° / _ . �� i �4 ,1,� y L.� w 1 � , r�:l lr.%/. f, ,,Yi.-: � Address: � �~ � � %� - , Phone # (home): _�,�1 . , �,x,j1. .�;� -'.<:.%; j'' c_;,/•'<.� �r�/5� J . ��� , ..� (worlJcell): =; :� ��. � 4, � �� ,�,� ia�;^/'/; ,'�'� -r yf�• �,� - l � � d "_ �)1'd�nnIl� �nc� a�clre�s of cupre�►t odWner (6f difgerent tl�an ��plicae�t): Name: Address: ' �� �Il'OgD�G'Lj� Y}���C�'9PtI0Yi: Lot Size: � � •. �., Subdivision: Lot #: Address and/oi• ciirections.to Property: %�, ;,i ;�.,�1, f:fl ;,f / f ��1... :'� f /..✓� i / �l v � .��. �` � f / J . 11 /�• ✓ � � - �''v.%� ) . '�7.a ;t' �,1�ir � :'k ,/' .�."' y� L"� ' �i) P�•oposed BJs� and T'ype of Ste�ucttare: � Residentjal .��� - Business/Type: � Other . Number of bedrooms "� / Number of people seived (seats/employees): ________ I3asement: Yes No (with plumliing: Yes No _� � Garbage disposal: Yes No � �) i�Jmtea• Seeiypty; . . '� Private Well �-' (Proposed Existing_) � � Community �Uell: Public Water System: �� Are tfiere on tlie adjoining properties? No � Yes � (please show location on site plan) 1�Iote; � corn�lete�l an�lication mca�t also include• Y� A pltai'/site pla�: of the prope�ty that shows properfy �lirrz�nsia�is rrnr� �lae size cr�i�l locr�Piora of �rll pt�opo.sed structccre�. � A signe�i copy of the `.Lot d'reparafion' form ver�zng thrrt idie prope�•ty is rerady io be evalurrterC. � arnn s�n�a�it�en� t1�i� appiis;a�taon to reque�t se�-vices �rotn the I'erson Co�nm�y He�fltIa �e�arta�ent. 'Y'l�� BYifOY']i21�D$fl0II �Y'Ui�li��(� iS �CCiii-��e. g under�tand that if �a�y sige is �lt�a-e� or th� flnt�aaa�ed a�se c��rag�s, �nH@ per�aits ��a�s61 1ne���� iaxv�➢ad. � �� `"",` �Ilga���u�'� (Owner/Legal Representative): y`��;r��:�� ' : �) �� ���� ; ` G` l/.%y , ,,.�'f % i ; � � � z � .� : , �� � };;+ j '.:. � ..� � �., �;::. i ; ;" ! i i 04/03/2008 14•27 3365991506 � -� � ��' S � ).�'. �7U ��r. .,�c)'` �. � �� C� e �s `�y, v ope � 9r? �'• JIMMY LEWIS 0 ?i � �� � •� • c, .� O c.r �' rnz . � � -< . �, r � � a� . �' • c-> � � � S� `�.. ._ `� r1 � � �4 � ' •� PAGE 02 � � i,; i ��: {:' �� 2: I• ) �' � �: �`' � �,� ' � - - . ��3��� ���� 0 � �, '15�� , �• ��� _...�� J� �c� � .�i � . ��`� � � a� -- � (�� v' N co -, . t� � v �, to W • f'�7 / . � � 1 ,1 �, �`.,` . a �� � � � �, �, ? • �,; °� ; + cn "' y'! i � K �'i i :U •� � v :�. S , � jr . � C: cn 1'r� , f� �: � ; . ; � - - .- .^ .- ^ ^- - � .,- �--� _ � . _ _. � - -- �-._ �._ _ ... ^•- i._, - • - S'� . - � ' �.• - �r,.� �I'•.i . �6 � ��J 3 � �.� '-cS 9 S ..—��. , - � _ ,..� ��:. ,..���� �� �,-�.'"..--"�-�""'3„6z,S'7..505 � ���8�„6ti.7.o� � o� � � ,__._ �_ , ,,,..,.. •- f� E L �, j .��.' :A � . 1,M�...-..s..�;',�'" _� n� 1 l V U• S.rl �� �`, � fl? . � 1"` ���� � ���� �� .�, . , .� � �� � � ���� I��n�-a�<� ��� s��.�n..]l I�3L � �zn,ll �1� T�x Ma�p , �Parcel # Subdivision Ph�se Sect�ion Lot # ' � � S� � � . . ,fl:�' �' :��7� -. Y.�II. - - _.,.�:�! .. . ��, ,, ,. �; Permit Valid for Type of Facility: . # of Occupants a Proposed Wastew Proposed Repair: Permit Conditions: Owner or Legal ] Authorized State !J '�e # of System: ,. Ia�proveane�t �ermit No ��piration '�/ �,� New Addition Water Supply VYB�� ooms �_ Projected Daily Flow 3(� o g.p.d. Type: � Type:�� Date: Date: - � The issuance of this permit by the Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not affe�ted by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for SewaQe Treatment and Disnosal Svstems' (15A NCAC 18A .1900). Neither Person County nor the �nvironmental �iealth Specialist warrants that the septic tank system will continue to function sarisfactorily in the future or that the water supply will remain potable. • Authorization to Construc� Wastewater Systean (%equired %r Building Permit) * See site plan and additional attachments (_�. Proposed stewater System:��nYP�l�g1 Type1E-R � Wastewater Flow R 3 .p.d. New � Repa' _ /E� x p s i o n S o i l L T A R. • 3 g. p. d J ft 2 Type of Facility: ����l c t t�¢, eS1��enC2 Basement _ Yes _ No iank Size: Septic Tank: ��� gal 'Wastewater System ltequirements Pump Tank: "—""gal Grease Trap: =-�»r' I)rainfield: Total Area: /�DD sq ft Total Length � ft Ma�mum Trench Depth .32- in �.G. Trench Width � 1Vlinimum Soil Cover: �_ in Minimum Trench Separation: � ft Distribution: �/ Distribution Box Serial Distribution Pressure PvIanifold Specifications: Authorized State A� Pernut The type of system permitted is permit. flwner/I.eg�112epresentative: )ate: �7-/3 �Conventional Accepted Date: 7'l7 ()$� Alternative. I accept the specifications of the Date: PCHD rev. 11/10/OS ,..�'.:.. : . . .� : �'�.,. .:�� . ;�. � � .. . ��, ..1:'•1-'.�:: • ' ' . .: y'•: ->..i:� . . :.: �.' :..;; ' .�:�r., �^ :•� . : ;�:':�..� �'�,\�'� '.',� �..: � , �•] �'L'1;"t9'f?ii']L��i::.`�:ir-n��rirn� �• .7��� . •;.,. . : ;..::.. ' � .� : , . • . .� .•;; ,.. ; .r.,.,.. .. .. • ..:.::�. ..^-----�-:•.R�3195:�`}.ie1:�'� �.�•t�'y, - . ... , .. : .. .. .....:, . . .. . .. .. � ' : 11' �� tt ��� ��5�1°IYlI g . y�1-���L:� 17�dJ �� AYiR_.� x�•� �J4Lj1V ��� V5'.i�lL.i� �7H11Ci.���LLJ 3 Tax Map �1-5� Parc�i # ..�� Tovvnship: Applicanf: I r r+nm� L.e .,�' � Subdivisian. Lot # �OC$t10T1: L L. dn� � � ..1-, n�! l ..� _ ��.�% _ '�yp� of'�a�en�,5a�g���y: \/ Individual Communi ____ ty Pubhc IBeqanir�a�nem�: Site Approved By: Grouting Approved By: � Well Log. � Pump Tag: � Well Tag: ' Air Vent: ` Hose Bib: � � Casing Height: � Concrete Slab: � � � ' � Well Driller: Well Approved by: :r***9e�.r�fit�r.�ed Sit� 5ketch*�** Liner: 'Installed by: _ Depth set: ` Gr�uted: Date: Water �aznple: Wells must be 10 feet from property linea. Wells must be 100 feet from septic systems. Wells must be at least 25 feet from any buiiding foundation. ��her conditions: Date:, PCHD rev 01!2710� � `��, �� ���� �� • . Y �^ ��y��y� ^ � � �1,�x�� ...6rI:����t�T 1�1FT ��.1��.JL � J�.��� . SITE S�TCH � .. Name .�r �CWIS Ta,z Ma # � `�� � Parcel # � � Subdivis' . r _ Section/Lot# � �'-i7 :a� � uthorized State Agent . - Date . System campo�rents nep�erent a�,proximate�contours only: The conimctor murt, fiag the system,�rior to beginning the insta�l�i'on to i�sure that p%�iergrr�de is �narntuined � �n�-('lQ� SyS�eM --3c�o .d. 3 b� 9�P l " �1 � �dnve�ona -- 32'' �,rehr,� boffams � ��68x SC�t� 1 "= �d, -1 �, (3 t � GU . L�':; �„6�,5:Z.505 w �� � Q, '� • c� .� c� rn� . � � --� . � r G � �a . �• n ���8�;,�t�.ZOS � �� �,... :n z � -i v' � �