Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
A37 27
A� iication Date: � `'�`� / A iount Paid• � � • RecElqt #: . Tax Mau #: ��� r-- Parcel #: ��( � ��� � ����_S� I��IC-�.� �� --_ ��v-��� �savaa-.mxc��----� aeaa��.71 �-�.e��l�a APPLlCA770N FOR SERVICES � IF THE INFORMATION 1N THE APPLICATION FOR AN IMPROVEMENT PE3tMIT 1S INCORRECT. FALSIFIED, CHANGED OR THE SiTE IS ALTERED THEN THE IMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECORAE INVALID. - . 7) Permit requested by: (Ownerlagerrtlprospective owner): �ti�U ,Ar✓U^ Home Phone: �'SD3-o1�72.. Address: �5'o rrto 7�3.luan ol Business Phone: 3� 5�9��-l��o� zfooru�, ,�/c z��5�</ 2) Name and address of curnent owner: ErK�lc� Car�w � i/h� �tlortox I7n/ba:� �o/ � �?oxboro, A�. ,2�57'y 3j Property Description: Lot size: 3Ac��, Township: Ohvc Directions to the property (Induding road names and numbers): _ Lot # h�vt�s� at 1N� end of Xh� ✓J ad . . 4) proposed Use and Struciure Description: answer eaci� of the following questions: a) Proposed , Existing �, Type of Structure: �r �dth: 3��: b) Number of Bedrooms: �_ Number of occupants people to be served: � c) . Basement Yes , No � Wili there be plumbing in the basement? d) 6arbage Disposal: Yes . No �C , 5) W�er Suppiy Type: Private ,� (new _ or existing�. Pubiic_, Community , Spring _ Are any wells on adjoining property? YesZf No _ If yes, piease indicate approximate locatiori on the 'site plan. � 6) Does your property carrtain previously identified jurisdicbonal wetlands? Yes_ No� P�EASE NO'iF THE FOLLOWING: ➢ A PLAT OF THE PROPERTY OR SfTE PLAN MUST BE SUBMITTED WITH THIS APPLICATION. ➢ PROPE3tTY L1NES AND CORNERS MUST BE CLEARLY MARl�D�• , ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST 8E ST�►�D OR FiJ�GG�D. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMEiVT STAF�. � I hereby make appiication to the Person County Health Department for a site evaluation for tt�e on-site sewage disposal system for the above-described property. I agree that the cantents of this application are true and represenf the maximum facilities to be piaced on tfie property. I undesstand if the site is altered or the intended use ctianges, the permit shall hecame invalid_ _ _ Owner Q� Legal Representative PCNa, �ev. ostz-rio2 May 1311 01:18p Cool Pool � �� �. ,�� : a;EQ �� `sa�ue�� asn papua;m aq�,�� ,�o �pa.�a;ig �pn pu��s.iapan I •;uaca�a�daQ q��ag �f}ano� 9108912665 p,3 :(anr��uasazda� �e�a�.�auhip} a.��y��Ts � � •��.tai a�uo�aq n�qs sJ�eo.�ddE pp� s�iur.�ad si a�s ay��! aa.�oaai s� papleo.�d no��w.�o�u� ay��! lsqa aq; w J saai s�sanbax o; uo���a�idde s�qi �Q��liu�qns ui� I pajnnJnaa aq o� �fpna.r sr �radoJd at�� �niJ� �ur�'r.ran tuta,�'� uo��n.�nda.rd �07, a�Jj f'o �i'do� patc�ts � G sa.�n�n1�s pasodo.�d �Jn, f'o uotln�oT pun a2�s ar�� p�v sumsuaurrp �,rado.rd sntot�s �v�j cf�ado.rd az�j�'o unJd a�rs�v�d y� � :aj7771Jt11 pSID �Sft2l! 2f01jDJtl n pa�ap uroa d: a�o� (uE�d a��s vo uat;�o� .Moys as8a�d) sa,�, oH �,sai�adosd �uiuioCp� a� uo si�a�n a.�a� a�� :wa�sns la�e1� otiqnd =lfahl �7tunwuioa (—an►�s�xg pasodo�d) f1a.M a;�nrld :�Iddas .ra;E� (c o�.( sa� :��sods�p a��q.��� �— o� sah :�u�q�unid y;�nd} oN sa� :auauias�g :(saa�Coldwa�s�eas) pa,�aas a�doad �o laqucn� � swooipaq �o .�aqiunN , � a�� � e �►M ���� .�ai1}O :ad�Cl�ssaarsng ��r�uapisa� :a.�n;�n.��S�o ad6,I, pue asn pasodo.rd (�, � :# zo-� c» � ���•�-�_ :.�.laaoid o� suoq�aiip ao/pu� ssa�Ppb :uo�sTnrpqn� :azrC aaT :uo�duasaR ,�.rado.�,� (� ` � �' � ? J �' • � � < � :ssalppH V � � ��� :au►e� :(�u�a�Idd� ue�t lua.�aJs�P,��),�aQ,�o �ua.xa ��o ssalpp�'�n8 ar.v��(Z ,, '��� U 11� — � �tlla�/��onn) .... �,� -:ssa�PPt� �h _ � �yJ �b :{awoq) � auo�{d � �1 ' � g�c�0� .-� �O :aure� � 1 •�q �a anbag saaxeaa� (T ma;s�Cs �gdas �ui�x� jo a�gdag uots�na�;rm.iad (pa�iuuad ucals�Cs3o ad,C; ay� uo luapuadap s� aa� uoqszuoq�nd aorWnl�sno� {lieda�aawa�e�dag/,ua� ;�uraa� Iia� uoi;�Pp� �uip��ng.�o;namaas�daa a�uoH a��qoy� tP� 009 <3�) 00'00£$!�0'OOZ$ (Qa�gnjen� aa�g} �rtuaad �uausano�.�dwI pa�sanbag sa�Yn.tas (SiIaA� Pu� s�aa�s�cg �udaS) sa�in.�as ao� uopea�jdd� ��� y u vr c� 7E--;� i� �'-� iuc ca u.aar ic�rc cb� �: ��n :c1I � .� � � � a� "� - _—� .�� ���� - S `��`� � �# I��d :#idia�a� 1- �p?�d �unouid L�'� � :dEy� xEZ - � („ � � " :a}e� uol���i�ddd 0 � �� � j* �. 1 / . . �,� y � � � ���� 1Ld�����.����i3i�.WV�i.JL ��i�.�l�� �uildia�g Additions/ 19�obile �ome Replacements Tax Map #:_ � Parcel#: 02 Approval Requested for: Mobile Home Replacement � Buildi.ng Addition Applicant Name: � G7� l� �o � 'ovl Address: �(�D /Lf�� - U /(Jd,�, . Phone #'s: Y(� �3(- �(Sa�4� Ylo �Q7 .. 7(q�p� �oh�lkcr ( �'� �'�--ev4(� s� �e�> Pernut Located: X Yes No Installation Date: �— Design flow: � (gpd) . Current Contract with Certified Operator on file (if required): �_ Water Supply: �_ Well Public or Community Wastewater system shows no visual evidence of failure on: (date) (Applicant's signature if site visit is not required) r , Comxnents: �''rt� s�u, � �i��'`(� �y 1��`t` � i►il�Sv-cu ����• �� Addition/lteplacement Approved � �Y�e.� S �? � Environmental Health Specialist Date `� 11/15/OS � May 1311 01:18p Cool Pool �1AY-ll-2ali 02:?5P� FRpI�- � �������,��s,y �,�� �.�� � � #io'I/ . �# F��d�# � ��'� .� - �� r��r� a'�ao�aa�bye+r...s�a� ��� � � � .�����CdL �S ��,� �� ,�b � � t r� ^� �-� o � o�-� 9108912665 p.4 T-079 P.Od3/005 F-699 �'S ,�� ��,,�� � � a � �1�j�y,� .�-� )1!y' � !� - �������� �� d� �� .��� �� ��� ��rs �� �r ��,.,�,.,�. .�.5'Q M o r�o � Pu, � 1� a,� 1�� . ��� Sf ���.� �� - � . - � `_'= � '�- cC � �J1�7F'�Y ]E�..�s�� � ���.Il IHCm �7{a. STTE PLAN / N e ►'Ll l Ve�' �"" � Sub " Authorized State Agent Sysrem companenta trpteseat appmadmate av�murs oaly. The iasurr t6at ptvpergnde is marmtained �( r`-�- ��arK�� ��e � ���� ;�k ��� G� � Scale: [ap #.�Parcel #� n/Lot# Date the systrm prior to bP 'e nninao t6e rasenllsrioa to s PCHD, rev. 09/IZ/Ol �,� S I���:.� �� . �,. . :. : : � � ���� �������.�:��.��:� ���.��� . WELL PERMIT PLEA5E SEE ATTACHED PLAN FOR WELL SITE LAYOUT Tax Map � Parcel�# _� Township: � --"----� ,l- �' --n � Subdivision: Location: T.Ot # Type of Water Supply: t� Individual _ Community Public Requirements: Site Approved By: 1%c'�1,� .S'7 � � Grouting Approveci By: � Df Well Log: � - - � Pump Tag: Well Tag: Air Vent: Hose Bib: Casing Height: Concrete Slab: Well Driller: Well Approved by: ****See Attached Site Sketch**** Liner: Installed by: Depth set: _ Grouted• _ Date: Water Sample: ,'l Wells must be 10 feet from property lines. � Wells must be 100 feet from septic systems. Wells must be at least 25 feet from any building foundation. Other conditions: Date: , PCHD rev O1/27/04 ,..��-,� S �~ :�:� ���. � �' ��' ���� �yi�a� r� ' � --�-/'� � . -� �� � � � ' �"�`�� 1• �l '{ 'Y �r ���� �' ► �iWl�� ,1�i� ,�_N�c i,J, ��,[ /�--� ���/j � �•- �, _. � �... .. . � '� �,�..�: �.o„-.���.�,�x��.� 1 :l:j1:r a..1 ��i �� � 3 -_-T_.._» 1�4'�11 Log Uw»a: �1�,.% __�.r.�.!<.r ___. Tsx �iap��� P•ice.k._�,Z ;..x;ativn. .t� _f71�.�_�D►�. .�u /(-,c �^ � .�..... _._...._--• ._. .._.. _. . Sutxi::�ia:un: ----._�. _._.._----.__....__ _ Lut # .__�----- N�ell Coaitr��oa Discaac+: }rux nr�:r. r�rn�c,.rty� i int !\iic�nu=r. i�i feet; .__..�_.-- Di�tuttce c::,a� S�-��•c S �e�*: thsr.::uu:n cG fcrc' � Tut;t: De;x}i �� t \•�':rlc::� _.�_.._._ ::i'�� �tit:c i��s:e: Ltvc�:. _ �� :, v�'asa F�taring IrLts� ;��pth .�-��= n .._.. _ :'t _..__ n .._._�.___ � l.'a�t�: Dtpth: rr:�m _. . .�.. :.^. v�,�_ it : -:tu�cc.tt _. f� f-� . ;.� 'i j�:C: i Ellv!ltJtCL' Slt?l:i -- . _...___ - V4'eighc; �� _ ''�ucic�ss;: . '/. � H�:�t .buva Grouad� / �, : Jrive Shoe: _.___... Y �s ,�:, �.��y �x•aira�:4, en�uur,:r:rd wt�a sect:r:�. c,a.�a:b ----`_` -i-'1�`' !f �+es" yive reosor� -- -- --.__- ----_ ._.. .�. .�... ..� - --- . _.. _ .. _ .. . .__ .. Gruus: tie�t: Syz:: �'rcnc.•nt ✓ C�0�1�7CIL` l)!`�1�CLC�ff�CT.� .�.��ul;;: �puce V►'��;tt� ._.-�__. _ _ :ru�hea Wa:�r :tt Atluui;sr :.�l:acr. . . Yr� .`�-� __. �lt�th��:i ��: Cir�,:s: F':�:prd ___ Yressure ' �uurtci .. .c./ 1)ePth .- - e7 tn . . . t• :�istsn� C'�ed: - -- 'D . \0 3:�s i��rt!�.�d .•sric::it WCSfX.�?►UF : HLL�T .�.T �OIlIISJ ;1 E'.1tXCl1C: .1dfi�i. �T.l1t�. i'iili7.".Yyt'- lt.illlC .� f.1 � ^ �ia:ey: r �x � ��,� : x �t siab �'es ! � � Uriltin� I.o� Lucet;ao nr��+it�g �F:rom . __. ~„_T? ... .. _ _Furiatilun �_. . _. . .. _. ... _ _. .. __.._. _ .... _•-_��_•-_-.,_ � _..�..�`_:._ �C�'.�'�,�, t+._i ! _.� Q_.___... _ _._._ Y. . �/ �., c. ��� ... .__.�,�_....� _� _. _Hi�-.r�_.�re�r✓1 �?'� _ 9�!... . ��r -. --�--I���___-�-+-=.�'--- -----�_ __. __ . __-._ ± _- ___..._.__ ._ , __.. ._____. _.,_ .�._.---.. . .:__---�-�--- _.__._... . �.��� ��.. � ��... � .. �....�.�.��_���. ' ..����...��r•�r�r ', ; . .. .. ��.�.��..r.�.�. ... .� . • � .... .�... .� �r�..� �. ....�w�... ��� .._ __ . ._ ..... .. i__ _�.�_..r. _. __�.. i. ..., ... ....._ •r�_� _—'__.� - - _'�. ._ _ . _. ._. . . _ ..�-.r�.,� ...��_ --•--_-- � �3CSdC�' ,'.�`C'J:'b' �3R1 '�JC ]b0�: :S!Lf.f7;�.d�:t)7: { i. �'.'CCS 1.TSL �►i.l! :ll 1 d. . iYiL•� �. 1:•C':�'.. � :T .a�. !.�:�1:.1 . ! + .•1'U.:a:: '11� �L'� !iZ!'[(! •!♦ ?il� i°�.:ti�.'ii �Iii�i1l1' t'1C.�:1� t)CJ�l`II1C2!.. �i�;oacure ot Cuntntci�yr __._..,__ _^, ____._._._ � ^ .._��3.� L•cr __�!b ' � �..._