A29 293.:�.
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Applican�
Locatiun:
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Pes�nat �Talid for ✓ �+i�e�e��s.
Type of Facs�i�: '
# of Occupaub �_ # of Bei
Proposed Wastewater S3�t�m: �'
Praposed RepQir: (�c c��.l�s_
Pemnit Condiiions:
Qwner or Legal
Autharized StatE
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�apa��effi� Pea� ;
1�T� �irai�an �� y �
`' � New ✓�ddition '4V�t�r �nPp�Y �f �t �C
s 3.. Psojected Da�y Flow �� g.p.d. 4_ .
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Type: �1G
Type: / .
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Uate:
D�te: s-ay�5
'Iho issnanco ,of tfiis pemlit by the Health Dapmtment in does n,ot gnm�ec flte isanaaca of other peanite. It is the responsibility of the
aPPli��P�PzTh' owner to in swrc that ail Pr.�son Cotmiy Plannung and• Zoning and Bu�7ding InsPectian9 reqnirements are met 'Phis
I�provr.�aent �er�lt is sui�jeet #o revocation if the �ite Plan, Plat or the intended use chamges. 7Ci�e Tmprove�nent Permit is not affected
by a'e3►ange m uwneraidp of the �gertg- �'�is permiE was i�aued 'm compliance with tLe provisionis of the N�a�th Carol�ua `Zasns and
c,i�• f„r Seeuase T�eutment mad Die�osal ,S`e+ste�as' (I5A NCAC.I8A 1900). Neither Persnn C:��ty nor the Env�onmental l�ealtia
Speciatist �rarrants that tB�e sept�c t�c �yste�n w�11 co�h►ue to fanc�iion satiafaeturity ffi the future or that the wa#er sug�ply vrill remam
pataLle. � " '
'An�oa��ao�a to ����c��'���v�ate�� S�steaii (�u�� �or �uit� �e�mit) .
* See site plmt and additinnal a�tQtc3�ments (�• �
Proposed V�asteWates Systein: i�►��•�- .
New X �� ��° �:0/ '
Typa of Eacslity:. �i.� � u �
`I�Pe4 Wastewater Flow 3C� . g.p.d.
So� I�TAit: . 8 O g.p.d.l $ 2
� �. -Basement -Yes �No
T �Fa�e�vater Sy�temn R�eqnirement4 . .
Size: Sepfic T�m�: f!'�_ g�l .�p Tank: � gal' . Grease Trap: " gai
fie1d: 'Total Area: �_ sq $ Total I,ength �_ �t . • Tren� De��a. � �a ma
eh'�Y�dth �_ ft 1N�-e����� S�il Cmv€a: �' [� ffi 1Vlinimum'heucli �e�azation: �_ $
� •�■a��a�� :•: �, : � ��•� i���
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�a$�ao�a� st��e Ag�: �
Permit �irat�on Date:
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.Pressure Mamfold
D�: S �y v5
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The type of system permitte�i is � Couventional Inn.o�ative Alteraative. I ac�ept #$e specifications of
the p�it ' y ' .
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