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A29 64Aug-28-00 09:33A • - �..•., • I I _ ��;•. .�� �. a• � � 4Sd � ��C�.i veG' i tJ /�0.� r:, .� :� �,�, .� . ; ����. ,«. � .. ;.;,. ,,,. . .,.`���.; .:, _ :. 1!� �• . -=.a, « P.02 ?�c li�.a s: �;� 1 E�lL�'�..._G�_,,, �'� a� 4� L7MQt'1�f110l1: �Isi111e! 68t�1 Of �4 iblldWi�iQ tj�iDllt: b) SI�k B�it a. AAodtd�r Q S M ti p M Wida C 7. D o u b l e W k b v ❑ c� Nwr�of 8ecboom�; d� Number d occx�ar� a pe� io bo �etwel; s) 8�sstr�tt Yot Ct, No ❑�� ��{p� ��_ ) �(�sOhp�p�C Yas Q No O , PropoNd �cdiro: N� , jS� [�: o' � •S w� ru �; u� � tA►I�b�l�„ppti► Typ+: p�ri�ra�s�li (nsw q ar ��, p„�q� q��r c7, Sptirp p Ne �a'+Ywdy on ac�okdnp ProPe� Yer l7 Nb f7(Ny�s, bc�dian 6) PI�NMs p� p�Nt+�e! � ---^' � �ri� �YP�� l�tims qtn b� �snk�d tn ordsr ofyoar prnh�nos) �� ._._M�d Cpweedanal ,�--,,,'oaw isp�tyl. —� _..Jmlovattw CtE�ARl.Y lIT4@ �1f,�,. C4RN�Rs AND UNQS CiF iHB PlROp�7'Y. Pt.EJ44E ��U�PtA�T � p�l.A�1� 7b Tt�l AP1�lCATiOM � �Y �Ice sppp�adan to tt� ���ed prop�rty. It�k �10 ai�B����M I�am �'ool c1,ue,us;o.vs �� � ft1iH �� tbr � sile �iYal��tlon �or tt� on-tIls e�yy�p� � arbOfp I�x ��� ioc afh !s al6ernd C+rtt� In�� � au4 aru! �p�r�snt t!N trvairllt�n fLc�tiw to be e�x! rrtatidrp Pr�p�j► � cortlers ,i� ���+orY1+� trnMd.1 urld�rs�nd m coaduct 1f� wak�, ��� ��y ,� �s 'd� � iar tfN � �ds aa d�eei�r�f�d 4j/ ths Amry Corp� ot ^�°� for �irp fM � �� vr.wn ,.r �nn��+a Apalication Date: � '� -0� Amount Paid• l�� Receipt #: 1 /., q� CJ�� Tax Map #: �� � ParcE! #• � � ������:�� ������ ' _�- z cC � iC�l�i "ZL� �Y �ffi��-��,.,--.-•- .e��.�.a ��m.a¢� APPLICATION FOR SERVICES CONSTRUCT SHALL BECOME INVALID. � 1) 2) 3) Permit requested by: (Owner/agent/prospective owner): �� ' � � Home Phone: Address: Business Phone: S��(g2�?� �' � - 'j--� w� �c+/ a C� Name and address of current owner: �av� � S � � f ,/ � k r - `t Property Description: Lot size: �Jh�Township: � Directions to the property (I�cl�ding road narres and,ryum�ers): :�_� . Subdivision: Lot # 4) P�roposed Use and Structure Description: answer each of the following questions: a) Proposed �,, Existing � Type of Structure: Width: Depth: b) Number of Bedrooms: � Number of occupants or people to be served: _� c) Basement: Yes�, No _ Will there be plumbing in the basement? Al'� d) Garbage Disposal: Yes , No �, 5) Water Supply Type: Private �L (new _ or existing�, PublicJ CommunityJ Spring _ Are any wells on adjoining property? Yesic No _ If yes, please indicate approximate location on the �site plan. 6) Does your property contain previousty identified jurisdictional wetlands? Yes_ No OC. PLEASE NOTE THE FOLLOWING: ➢ A PLAT OF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED WITH THIS APPLICATION. ➢ PROPERTY LINES AND CORNERS MUST BE CLEARLY MARKED., ., ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAFCED OR FLAGGED. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMENT STAFF. I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage 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 invalid. ��� �� Owner or Legal Representative ate PCHD, rev. 06l27/02 � �-�r ���� ��',� A 1756 P RSON COUN"rY HEAL'TH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IMPROVEMENT PERMIT Tax Map # � �j Parcel # �� Zoning Township (� l �V � i-� � � _ Owner/Contractor �,�G1,me �h �'-4- Date �{ �Z(��qg Location/Address_�Z� ����� I-�eS S.R.# Subdivision Name Lot# Permit Void after 60 months. Permit Void if not in compliance with zoning regulations. Permits may be voided if site is ered or inten e e changed. Well and Septic ayout by _ �� Comments: � — Date —1 Head Date Installed by WELL SYSTEM SPECIFICATIONS Semi-Public Installed by_ Required Slab _ Air Vent �� Required Well Lo� fi�1 \ Weit�a� ,� 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 ffie septic tank system wi11 continue to function satisfactorily in the future or that the water supply will remain potable. c�amipro�pemut.sam O1/95 rev.1.0 ORIGINAL � � � � � �. , � 4 4 �� ti ti. 1� � � �1./ .�ti. �i � � J:I�S��.����1 �T'T11T"iY'111���„�.�L ��i�.Ji�3W. �uilding Addations/ 1D�obile �o�e Re�lac��ae�ts Tax Map #: / ' � ( Approval Requested for: Applicant Address: Phone #'s: Parcel#: � Mobile Home Replacement � Buildi.ng Addition Permit Located: � Yes No �/�' Installation Date: �0'`�� 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: �s 2�—�rP �(date) � (Applicant's signature if site visit is not required) : . A�diiio�eplac��nent App�avecfl � �Yv-�r � ^v� �`� (p En onmental Health Specialist Date 11/1�/OS . .. " . ' � i:';rl": ' ,Fy`r . 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Home Phone# cJ`�f0-299'%Oy`� � �(� ` � Business # � � --c-venS��,r� _ 0?�'4�F'1 Location: Z� Z� 1 Y� ��i�P�(' � Original Permit Located: � Water Supply: pr; VC�.� Septic System Designed For: esidential Business Other # Bedrooms (' # Employees Other System Type:�D�,%�l-�t�`LCLt' Tank Size: o� �J Nitrification Line: � 35�k3 � Date Installed: d1 ��� 9 q Certified Operator Required: `"I�) On-site wastewater disposal system shows no visual signs of malfunction on 5�5 � 2 Pernussion is granted Environmental Health Speciali<. � � � U � a �� ��-�-m �- �� �er� � f A 0 01212 � � PERSON COUNTY HEALTH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IlVIF'ROVEMENT PERNIIT Tax Map # � a C( Parcel # � Q' Zonin� Township , - - — Owner/Contractor J i �M C�, r'1— ,�Q Location/Address �F 9 S' � s� I l� �� s� Subdivision Name _ Lot# Date SEWAGE SYSTEM SPECIFICATIONS Lot Area Size of Tank Mobile Home Size of Pump Tank # of Bedrooms Nitrification Line ��^� Max Depth Trenches Pernut Void after 60 months. Permit Void if not in compliance with zoning regulations. Permits may be voided if site is alt ed or intended use chan ed. Well Layout by , � ��t�� o Comments: Date Installed by Approved by �,,,�t �,s WELL SYSTEM SPECIFICATIONS Indi 'dual_�_Semi-Public Required Slab Public Re cement Air Vent Site Approved Required Well Loo Well Head Approved Well Tag Grouting Approved Comments: Date Installed by Approved by This repoR 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 environmetrtal 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 applicatioa Neither Pecson Coucdy nor the environmental health specialist warrants that the septic tank syste�n will cocrtinue to function satisfactorily in the fut�ue or that the water supply will remain potable. c:�amirno\oerrtutsam O 1/95 rev. 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