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A28 136
od �,Amou:it paid ��• .. ,, , , � , —, Rec�it�t � � �► �# 1 �3. a , � H O � Person Courty Health Dep: 325 S. Morgan Street Roxboro, N.C. 27�?a Gourier �2•?3-15 8-18-9� Date Improvements Pecmit. (Established/Recorded L.ot) _ Reinspection of Existing System (Loan Cl ImpFovements Permit (Unrecorded Lot) _ RepaidReplace existing Septic System Improvements Permit (Mobile Home Replace) Improvements Permit (Addition) for New Well _ Replace Existing Well l. Permit requested by: . �wner/prospe�ctive owner/agent: _ 7. Dimensions Proposed Structure: f Width: oZ Depth: �, a v Home Phone n:o..��� -NS��-� �// � usiness Phone #�3��-- t3�'� � 02�-0� a Ny�e �n� address,of,current 8. What type (if any, additions, expansions, or replacement is anticipated to the structure or facility tha�th�s s�ge d Jspo� stem '� intended to serve? � r o � er: 9. Water supQly t}'pe: private'i� . public ❑ community ❑ spring ❑ � Are any wells on adjoining property?Yes ❑ No �. — If so, identify location: . PropeRy Description: L.ot si e: �� C- . Tax Map�: � . -c�Z- �-'� � � -�a�' Parceln: ��%r� _ �o . Township: �'`��f'�.� ,��� . Directions to prop�rty: State Road r& Road iames,�tc. �J c�S S-�PT 8�1 ?,l.�,lnc.� �r�...�� ✓ .PD ,C.�".�'T d .� _- z .� Number of occupants or people to be served: 10. Type of structure/facility: Proposed: �Existing: Q Type of dwelling: House: ❑ Mobile Home:�iBusiness: ❑ Type of business: ►Number of Employees: Number of bedrooms: .'�'�_ Garbage Disposal? Yes ❑ No 0 IBasement? Yes ❑ No� If so, # of basement fixtures: CLEARLY STAKE ALL CORNERS OF THE PROPERTY AND THE CORNERS OF ALL PROPOSED STRUCTURES. I hereby make appiication to the PeI'SOrI COunfy T.-iealth Dep3rtment for a site evaluation for the on-site se�vage disposal system for the above described property. I agree that the contents of this application are true and represent the maximum facilities to be placed on the property. I understand if the site is altered or the intended use changes, the permit shall become invaIid. I understand that before an Improvements Permit can be issued, I must present a survey plat of the property to the Health Dept. I understand that in the event I have not delivered a survey plat of the property to the Health Dept. within 60 DAYS after the date of the evaluation of the site by the Health Dep[., this application shall become void and all fees paid forfeited. � - ...-____---------- � :� _ j Z ; i� �•�. �6� `S ric � ;: W" 1. 6 3 -� 4 J � v O �- �; ' � ACRES o � 1 . 3 � - �� � - � .��,E R. �Ro� ,� � � A C R E S •`� � , T so-E-zia :, ts y � oq o� � , , g . e , � g k�� .- �S _. ,♦ �� � 'S��o3. � ,.zb•E � -; h" 3 r �x�e �� �3e.s,. "►s N�a,00 oo. �a.00� c,� r�°`' 1. 3 7 ' g..�'' "S � � � -.- 6 Sa.00� NF "5 �— - - -� '. ACRES �, - - o �. �� iS �5.86' �r �� 9�' IS W , \ � • . � � � ACRES , u � "S` ��.00� o � � t� � � �' r. c } t � — �O �� .o _ , Q' � ��� � 't < ..� , ^ ^� �b � 1 • " `� ��', � a 2 �►b '�.4� • a.Z �(.yl� � � � u i � n��+ 5 ; . ! ,� � � v t � ' , o� i, !3. 70U. �' t�G� � f ACRES � ^ � \ � , . i. Y f � J�.6�' � �� 317.99' �J . I 15 Ne7'ts�s�•K � _ _ _ _ � �S � a i: ' � —__— �_ ' X � � �� / IF ' - � ; X Y'� �O�jL{G'.f� �-- ' T�� J�•op. � } i � 1.� �r. �,� � i � � � �.�1= � ,i�.��',-�J,�' � ,�` � "s � � i �� . � JENN ■ / ` ' -_ � leeEN� ie uoaao� , �� f,�= �� < �;;HF �� � N�tll FOUNp 90�•[ •»d � `�� `� O.f3. i9), v. �9� � 3�: ;�::►+rS_ o t�t.� ! � SE T � ar `j' �':.�lf; �, JRON FOUt�tO IRAC T j 1 / z c_ `�, �"��,.� O �R�N SE1 'RIN$1EAO. IN� . �� p.C. i. v ��6 / �; ,�t '�;,ip o u�1HEu�lTICa� • POlNT � ^1J►+tESS SJG+�EO. SE�lEO �rr0 O�tEO, rH�s !s • .�tIYIN�tRT PLAT, NOi FOR RECORO��ION, $AlE$ ` '` � OR.CO+rvEriu�tCES. c i ; �, � �:;� �a .. � . t . �°,,��4� ° V_ �` �: � HAI�IIETT—JENNINGS � � �; ,�T:' -= �C ASSOCtATES. P.A. • . r : �� �:�.,RECtS1ERE0 Uw� SURvEYORs :��i t2 �5' L/l:t�tR STREET - PO 80X i 266 � a: s�" ROX80RC NORTM CJ1Rp�1l+iA 2 7 5 7 3 � , (336) 599-8742 � ; S��rC or No�ti�� C�kOL INA • COUNIY pr P�RSON � • . ' REvIEn 0« ICEN Oi' PERSON COUNTY, CERi1FY iN�lf TN� uAP OR P�,11 i0 �NfCH TN�S CERi�F��,tiE IS AFFIXEO uEErS ��� S1A1UfORY REOUIR[uEN15 �OR RECOROING. ,.: .'; ,'-, ..; . ...... ..... PERSON COUNTY HEALTH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IMPROVEMENT PERNIIT ''= 3081 Not for waste water system construction. No permit(s) for Construction Location or Re[ocation Activity shall be issued until Authorization for waste water system construction has been issued. Tax Map # � o� � Parcel # Zoning Township Owner/Contractor � r rt P,�I-+� Location/Address 1-�Q � i�, � �Q_) [5� A Name rt �■o C��:g..�1G � �R,�p.+�cl. S.R.# Lot# rf v' SEWAGE SYSTEM SPECIFICATIONS � Repair Lot Area Size of Tank / b��;`��- W� ' ��i�!'�.•l SFD Mobile Home �/ Size of Pump Tank Business # of Bedrooms� Nitrification Line �t'� � xc3' Max Depth Trenches �f "' � � v Permits may be voided if � Well and Septic,�,ayout by_ a Comments: ��o r altered or int�ded �se c � . � . i • � � . : . � � � • - � � .rr,'i%�v%��,�.��%1/ ell Permit Paid 0� WELL SYSTEM SPECIFICATIONS Individual �Semi-Public_ Public Replacement Site Approved � -� Well Head Approved - � i�r�n4in`e !� r�r�r�c�n� � I 1_ 1— Comments: Required Slab � Air Vent - � Required Well Lo � Well Tag � - - ' Date � �- 2-� Installed by �(/� �� Approved by / This report is based in part on information provided the homeowner or his/her representative in the application submitted for this permit. The environmental health specialist is not responsible for false or misleading information contained in the application. The environmental health specialist is also not responsible for concealed conditions on the property or for statements in this report that may have resulted from false or misleading statements provided to him in the application. Neither Person County nor the environmental health specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. c:\amipro\permit.sam O1/95 rev.l.l 'i'�,: _• JEH►+lE R, ►i0KR0: 40-E-ZId W: � . � � � :;:�. a r�_':, : x xl E r� ��� �;�:; - � - ��:�� . .�,;,_-: . FTi .' �t'� f'�,: , �. � � 3"�: � t.`L O � -1 �• . o� 2 Y' . � '1.60• i'• �F '�" I : i,.' . �� , ' M � , � ,� �� ���i'ecENo ; � �-!� �N!� ! 1=: F OUkO �`�N.l j (;•..: $E i . .,�. . ' .;��RON.. FOUND ::. ,���;�R�N: SE7 : . P�'O.' �caTHE�t,�T1CAl • ;+•:,, �" ;�; pp 1 N T .: �4::� � ���. � i!1' '".l Y:' . ESS;SJW�ED. SE��Ep aHp OatEO, tHIS IS � CJ�Iw•Ar A�Af, N01 Fpft RECORO�(►ON, S��ES CO►tYEYiu�tCES . �:; . -. ���A1�1lETT—JENNINGS � �;� . �'�c��:ASSOCIATES,-': P.A. . . ZEC�S7ERED UW 0 ` SURvE1rORs S:�uuR STRE£T - p0 80X 1266 � �RO NORTH Wtp�l►L1 Z 7 5 7 3 J;`�`. ` (JJ6) 599-87t2 .. _...-- - . � i �1 -�L._ ) �/ 15 hC 3 1 . 3 �' ACRES �, � �� � li � :,��: "e���s�s..,, - _ _ _ _ � / is _J '' E k � �F � ---- — �- C�- � %C �, � �� /) �_ � �,� ,�' � _" i .� � T � � �1 �. j.t_ ,.� ,C ),.t- � � . • Op . � ` - ^ rr5` ... �1- �=' l.:>,a,� '��,�=j �...,�,_ � � , _ �fNN(E �. u0RF10■ / I 90•C •7)tl 0.f3. �9J, P. �9� / • / rR��► S� � 'MIN$1[AQ IN� • �'.c. i, v ��� / � � $14f( 0�' NOAIIi ��kOl IN. . COUNI r Q( c���lSON �' ' � Kf�1en o��►CEu OF PERSOH COUNTY, CERiifY r„�r Tr+t u�A oR P�at ro xr+IcH rH15 cERrI�Ic�rE i5 AFFIxEO uEEiS �l� STAIU�ORY nEO�IRCvENiS �OR RECOROING, � O � 60, ACR�S ��J .3� o� . �Sd s � � 6 � . o0 is IS A C R E S �,-��, ' �� O (�� � �� . . ..�b �` .` l ��. �.�;�, .. ACRES IS ---� . N�g'2���6, �7.00 �. �oo .00 . 5�.�`� "S c' � N$ _ _ NF � � � ' , � � � <5.86' �� �' y � . _ .� �� , � �,�s. , � .. , � ., J, � � . ` � `\ ; v ' ,,,,, - � ., � � ' , ', - � � . b �� Z�1-�-5 ` v � � r , �- �• , � /� � ,� �� � .. ,.r ► � � � , , , � ► , ►1 `� : �01-5 bb/�-/�/��Z/��; �4 v' " ' � � bb-SZ-Ql r1r � . 31 � . 99 � �s Na�� �3'S� •K � t� •� � ^ ` � . � U ,: ti ,' JU %' .; � � ' � � "' 1 '1 � -� �� , �- •� I F ~ — ` — -- — - c� � � � . .:� � � � � � i; � ,- , ..-- c r� � . � � . +i �: �.� � . � �",.. 1 ~,~" w.. /.� 1 i . _ ; � -. �. .T.� • � � �iav T e5 '' .._,._ No,��_ . ll� � '. -. _. _ . _ .. ..._ ...__,._�� ��...�..,,pt.; ---� -- -�__ . ..�,.. ,. � --, - --��.�...�..�,__ � - ---�...._ Pormation D�scripciort ____�-��..,. �_ _. --�.,�... ,�.�._. ��x:� _ ----�---.. .__.__ � _� .. •_ .����4� _�--_� �'�`_„-_ �----.... ���.�-s.,_.�,R�----.. _ �. _- -- - � _ - ._- _ ��. . .. ....`�---� .. ��^_- •�, __.�. --. . _._. ! �1C;Rl�.RY CFR'I��YTHA'I"TNEA$UVETNfiO}t1�lr�'1�1C.�1�' I:' � - -_. '1�t�1S Wt:L1, ���s t:�oNs�rRurrF.I� �Iv ACcURD��Nc:�: ��;r('i H�RkE;c. i��N�:���-t�,��i• Fc)[�'I�E1 F3Y TH� PFRSC�,�' C;)�';�•y� HEAI.:rN n����kTr���=KrKrr.,i.��.,.41'IC?`�S S[�.�i' -���� . _, _ . . � �1gIT$lt1rC Of �.�i1C1(iJC(��I"�_..__ ._ �._ , . /Q,-/.�_�� n�,:�. � �..., ...,.: � .. �,. _i o �, i ,,.� FEASON COUNTY ENt•1ttONMFP�iAL N�AI•'�1� W�ll. I n:: � I)aic: ,�D - �� '.�.9. 'n (� �� n c r : .X���x�_ . _ . . ._ _ - S 12 t� I.cx�;�ti�?�ti Ll ns:�f9.S7��i� . ..�a��,C� .�r..,�._�,�7;.� 07,!� ....,�.��:. �..c�- ...,. .__. .. .. . ., .----. -._..._.._._ � '�,11,�ii��i�;i�n Name;,�a��..�'��-� �.�u�.�. .. _.. .... _.._ . l.ot t� ^7 ` , r . I.�ri I I in� ' ,..._�..._. __ .� -----�- -� ��---_._ __ ... �._.,...� _Y �_.._ (.�F�tr�cl�r: w�1�.t��:�1G.r..(�� . 17i�.i,utrc f►��rn Ncatr�.s� f'�c��x•rty l.inc_......�--�— i7isl�nt�: irc�l�t $c�urc;�• c�f i'�11»tiort Z'��t:�l T)c},th'. /�C� __. . Ft. Yicld:�,�,.__ GPM Static: Watcr I.,c••el I�t. �1':�rf�r t3earir�� :Lonc�: �ap�h }�t. �t. l�t. ft. " � (.a5in$: `I' Y�' F.:: nepth: rro�n. �.1� __._lo� �t. t�iarr+et�r: ,��' _.. [,iches Steel _.. . _ ��.. _ Gulvttnizeci Ste.ei �/ �- � �f Stccl, dc�es owner apptove: 'Y�s.�,Nv - �_.w'_ . . ._—�-- -.._ Weighl:_.,�,�� 71�ic.kness:.✓ g� „}�eight Abo�� Ground:�/�,2� ��nches Ihive Shc�r.: Xes ✓ Na_ _ � Were i'r�bl��m s Encc�urt[ereci in Settin� the C":��ing .' Yc$�� .. . w No� �v _ If "}•cs" giti'� r�a�son:--- .- _ c;r���,t: '1�Y��e: �lea�---� _....� SandlC�ment � T - -•-t ;� . _ `....... . ncr�tc�-- Arinuiar SE�acc Width_. _��_��c1�rs � �yater in Aruiular Space: Yes __ ; No� �___. hlcthad: P�unped�✓ Pressurc,,.,_--- _ Aoui�� !)cpth: i�sc►rn_,� ._(,�_ to�_ rr F�' ,...--.__._.� . ., ^.. _., . . . . .,..,., � � Materia�s lJscci: Nc�. $ags Portlar�d C�meri�._,.�._ 1Vei�,ht of 1 l�ag,�_lt�s. It n ' i d iucture ,sa�� , gr$�el, cuttmgs) • Rat�o:�..-� 'o.-- 1D Platr.s� Ye� ✓ �!„ —'�— - �.��� .' �+ I �V ... 4 x a s��b Ye��.. ��to � � � � - -- • �- - •-- ..... . . .. .. .. . ..,_�,�,.K",L` �.�.,,Ll ,�1. �ep� � o . _. _ _ ... _. .._.-- - . . . .. � .-- �'rorn T� - •�---.•� _______.-� -- --.�. . _. .. ..�..�,.,. _ , . ... . ._.. ..._ , �ormation I�escript�or� • .-. .. .__� --�---_.. d .... __-�- --------......._. .. � '�` --- ��,�, . .. ____.�.. .�. .- -- - _.._.. .. . _. .. �,.... .�6 _ �,� .� �----�,-- ..._ - ... � ����._ .._.. -�-._ _--�- ---_-`_.�_"._ � .. . �__ _ _ ._ . .. ..__ _ _..,_._ _...� ._ . _ . __:---. ._ .�....�.. .._. _ ____... 1 }1;�,Ri��i'�' C�.R'1'1�`�7HA?"i'H�ABUV�TNFOkt�i.1'�'IUT�' I:i C(�RItF.t""I'ANI:)"!'11A'l� �1�}ilS W�:L1, u'AS C�nNS"1'RUCfFD W�Cc.;URD;�N��; v:TCH Kf�C�l.jl.A�1�iC?,�1 �E�.1- Fc�k�r�� ��- TE1E ��RSC�,� C��t ;�'t'�� EiEAi:i'N I)�Pr1K�rn�k,i�i'. � -��� ��_. . . _ . _ a .S1 naturc �._.�.--- �- �---� . .. � . � � �� � Of (.��ill[aCtot (��.�.