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A35 47Apalication Date: �� Amount Paid: 3�+�/b Receipt #: �.81�f(. �$ '����_�� ���� �� — ._ � � iLTl�'IL� � � aa�sa-�+aa�-�--� �as�mll. 1L�o�.]L�1�a. APPLICATiON FOR SE32VIC�S rax v�a� ,,��-�S� ��rcEl #: . `TCo�ff' IF THE INFORMATION IN THE APPLlCATION FOR AN IMPROVEMEiVT PERMIT fS INCORRECT. FALSiF1Efl. CHAiVGED OR THE SITE IS ALTERED. THEiV THE 1MPROVENIENT PERMIT �1ND AUiHORIZATI.OM TO CONSTRUCT SHALL BECOME INVALID. � „ < < 1) Permit requested by: Owner/a ent/prospective owi Home Phone: °I 19 � S�O� - a`6 a�] Address: Business Phone: SG3 -�7K� 2) Name and address of current owner. EM�a f� � k'�L�.11^ - 3) Property Description: Lot size: Township: Su Directions to the property,(Inc!},Zding road,na►Y}es and �umbers): � K�� ��`���� -�ti�r �' w�l 4) F�roposed Use and Structure Description: answer ach f t e f Ilowing questions: a) Proposed _, Existing �Type af Structure: s� v-: �• Width: � Depth: b) Number of Bedrooms: ;� Number of occupa ts or people to be served: %F-1ci. �L�oot,n . c) Basement: Yes . No _'�/Will there be plumbing in the basement? d) �arbage Disposal: Yes , No ✓ , 5) llNater Supply Type: Private _(new _ or existing�, PublicJ Community� , Spring _ Are any wells on adjoining property? Yes_ No _ If yes, please indicate approximate location on the '. �site pian. 6) Does your property cantain previously identified jurisdictional wetlands? Yes_ Wo ✓ PLEASE NOTE THE FOLLOWING: 9 A PLAT OF THE PROPE3�TY OR SITE P.LAN MUST BIE SUBMITTED WITH THIS APPLICAiION. ➢ PROPERTY L1NES AND CORNERS MUST BE CLEARLY MARKED. �, 9 THE PROPOSED LOCATION OF Al.l. STRUCTURES MUST SE STA�CED OR �'LAGGED. 9 TD-IE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTME�YT STAFF. I hereby make application to the Person County Health Department for a site evalua6on 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 permii shall become invalicl. . or Legal Representative r-�z-os Date PCHD, rev. 06/27/02 N � d M v m c m m �, N m U Ql A m N m m � � M 0 z ¢ � � 0 � � � � z J O � O � � ti O � � � . �41c:C;(-II::L::> MII..I_ t��r� . . . ' i.l+�. 13;i % i� C'EF1'p - ""'._._.._ -- -- --- _.._ .... , „_, ._ _ _ . h�' li/W -_-�_�� S85`I�� � ��,� - ' _...,'..._..-.._...._. �_ � ,._._.-._._. _ .� .____--- — — -- .... . _ ,.__._ Q-,---���. "c� c�i...._.------ sri5-re�l�r'E se6• ra �;,rt.����:�_, . Q.R � to N 'rHAr.r n 0.55 ACReS fV86iD7'OQ"w 11 Q ~ r � r } ^ � �� --�__ _.._.._..-----..__ _..... 2 t� � t, 133.28' �'.....__T..__..--- 7 ' 7:3.�f6' _ o � "" -- ..._ — ---�?—..-� , _. .. � � Z i � 1 TRA{:T C P I 4.:s3 =ac;�[s . o i � � �r � . 1RAC7 B �'�?� �� � 0.68 AG1ES / ' ' R �" ' w _p ���✓ , Nf ao . � • r- . � oi ' � FXIS7ING • 1 HQUSE � I � �_ N87'1 B'17"N/ 1�46.57 " ���`� . ��� � , Sflq%17'?U"E. �8if"14'3H'�E -� ...-9t.;�' "-..._..�..._.__..... ft?.:51' —..._ � r "�-- — ..... •.�.,.� • _ , � _. ! _.�_ � � E J • c► � na E� 7RAC7 E � ,� g i \\ o.sg ac�tr•_s � N� �� n . r QQ ExISttN6 � , �''- HUUSE • 1 . °� , �1 � . ��. ^ . �� UNINHABtTA6lE '� , � � TRt�CT D � � ��4ELtJNC. _ ih �, �.�, ACREs a r ' c 2.. 2� . , v? - ' 1 . •1 .. j. . . .� . N37'49'1U"W 6 • N88'�9'�3.4'W � � .. s���s��rw� �� �s.s9' . f52:87' i ��� ; I �,�g' ;. i . . ; � � i � ,129.98' � � Application Date: )'`3� r� 7 Arnount Pald: � Receipt #: Tax Map #: �_�� s� �I�I�� �� - - ����-�� ���.���,.-,.-.. ��.��.� ���.�.��. APPLICATION FOR SEitVICES ParcEl #: IF THE IMFORMATION IN THE APPLICATION FOR AN IMPROVEMENT PERMIT IS INCORRECT, FALSIFIED, CHANGED OR THE SITE IS ALTERED THEN THE IMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. � 1) Permit requested by: (Owner/agent/prospective owner): �f}�5�.� �/ '� �o � , Home Phone: .3�1 �� y� . 9� $�6 Address: YZa-� -� 8usiness Phone: 3�/_. .s-�r� i ��� co X u o� >1� a� 5'� Ca 2) Name and address of current owner. �i�kti E�! - S v v� �� � , v� r� a ��_� o ��4���..d %� �o . g-�, � `i.� 3) Properly Description: Lot size: %,�� ��Township: Subdivision: Directions to the property_(Including road na�ne,s and numbers): Lot # ` 4) P�roposed Use and Structure Description: answer ach of the following questions: a) Proposed �, F�cisting � Type of Structure: U,O,��,-Il W'dth: ��tS Depth: 02 � b) Number of Bedrooms: `, Number of occupants o people to be served: � c) Basement: Yes , N��there be lumbing in the basement? � d) �arbage Disposal: Yes � , No � 5) Water Supply Type: Private _ new _ or existing�blic� Community , Spring _ Are any welis on adjoining property? Yes o_ If yes, please indicate approximate locatiori on the 'site plan. � 6) Does your property contain previously identified jurisdictional wetlands? Yes_ � PLEASE PIOTE THE FOLLOWING: No_ ➢ 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 STAICED 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 faci j�es to, be placed on the property. I understand if the site is altered or the intended use changes, the permit shall Owner or �� 1 ~ � � a � Date PCHD, rev. 06l27/02 l�ic�hees Mil� Rc�, . S,R, 1337 C60' Pub�ic f� --_____ � � W � —____ . S 86°19'S4"E � S 87°11'O1"E 132,54 ' • co 7 3�, �811 — J � � I ---� 1: '�� -,-- _ � _ 1 • : . L` � J ' , . , 146,56 L2 - N 87°16'�7"W Jar�es A,Long IV,Trustee W.B, 71-E-8 '. � r n h��� � Y("�f � .. � �� l � L�-� 3 � � Tracy D.Griles'. d- � ` D�B.. 195-2 �-- �o �-, RESIDENTIAL 00 in EXISTING Z�NII o - �� _ � � I : - , 62,60. � N 88°20'08"W � = Gladys DUncan et c �NDF�` � I � : �.. . � 0 � _�� ��� ���� ��� : � � > 1 1 � � � ���� J.�.sn.-�-n.a-�„-„ „-,t-n<es��.�.11 I�L�.m.]1�I1�n. Applican� �, P�x�t 'Yalid �or ✓ �ive �ear� ear Type ofFacility: ��� e � T�x Ma�� � � �rcel r Su!bdivisiar�i Fha:S�e,S�ct,ion:'Let +� l[�npraveiaen� ��rmit iYo �iira�ion � % ���rS��i� ) . Ne�v �/ Addition �� �ater snppdy - e C! Projected Daily Flow � g.p,d. # of Oc�upants �_ # of Bedrooms Proposed Wastewater System: CC Proposed Re�air: � Permit � . � ' _ �G' Type: T Type: � � S ` .- _ Owner or Legal Representa ' ignature: ' � �� `-' � / Authorized State A � ate• 2-,�3-�7 The issuance of this pe�it b the Health Department in does not guat�tes the 1ss�,�r of other permits. It is the responsib�ity of the aPPli�Pr�P�Y owner to in sure that all Person Cauuty Pianning and Zoning and Bu�dmg Inspections requaemeats are met. This �provement Permit is snbject to revocation if the site plan;�pTa#''or'the intended use changes. The Improvement Permit is not a�'ected by a change in owner"si�ip of the property. This permit was issued in compliance wit6 the prnvisions of the North Carolina, . `Laws and Rules far Sewage Treat�nent and Drsposal Svstems'. (15A NCAC 18A .1900). Neither Person �ouniy.: nor`�tlie.`` �� � Environmental �eaIth 5pecialist warrants that the septic tank systetn w�7t continue to fnnction satisfactarily in the fntnre�or:tliat. the-water supply will remain potable. • • � A�thoriz�tion to Constrnct �Vastew�ter 5ystem (Required fur Bnilding Permit) * Ses site plare and additional attachments (_J. . � . -. .. � Proposed W ter System: �iCC�p�e� �. � � Z`y'Pe _�� Wastewater Flow �.p.d. New ='�Repair Ex�apsian � .� Soil LTA�: � 2.�g.p.d1 ft 2 TypeofFac�ity:��a� �eSrdPh�;;� � Basement_Yes_No r � �'�astewate� System Req�rements � . . . Tank Size: Septic'Tank:'�0�6 gai aamp Tauk: —gai Grease Trap: --gni- - Iarainfield: Total Area: %�� sq ft Total Length ��- `'�� ft ' Nta�mu� Trench Depi� 1 8� � in� . Trenc� Width 3 ft lY�ini�nm Soi� Cover. _� in Minimniri �remc.i� Sepazatimt: � ft �. IDistYibution: ✓�I)istribu�ion �oz ✓ Serial �istribntion Pressnre Manifold . � . ,/ /��.;:._��.. Spe�cations: .Sc�►w�' o� �-6oX a�i. j t� ���ae>c ,n.�a�.��r��M c'�t{�� ���'iz�lf� F'ee�;.: `;.. state A.� Permit The type of system permitte� is P��- � i�e�/�,�ai �t��a-�s��tatave: Date: Date• 2 /3-0 7 Alternative. I ,�.�e spe�ifications of the ��-13 -6 � pC� rev. l I/10/05... ,�_ .. .. � _ -`--��y;,�,� �11d�„��� • . �' �. � ���� IE�..��-m��e��.Y lE3C��d� . , SI'I'E SB�TCH � .: , . . Name �e �- 5 n Ta.z Ma.p #%� 3� � P�rcel #� i Subdivisio . � Section/Lot# . . L-�3-o7 . � . thorized State Agent . � Date . �. � . System cvm�ronents mjimrent a�i�s,oarimate�contours o�ly.' Tha coniracrMr must, flag ihe system prior to . beginsurig ihe i��Aation to i�sure thatpm�barg�ade r:s mari�tained —�+,,,�-i1�a � SyS�2yv� ��ic�hees M�E..� Rc�, S,R, � "1337 C60' Public (; � ❑ �n/. ) ���5����� V���, IL`, � J S 86°19'S4"E • . � �. s , �, Jar�es A,Long IV,Trustee W;B, � 71-E-8 ' � r n hi�� 1 i("�r'. .. S 87°11'Ol"E IV �t3 CU U�S W S�A���' � �� ` `��� � � � J ' Y • � � ` ^- �{{ `�.�- � ° " �' u 7 �1�� � � ��! 1 � ��� �� �S .1�,� ��[ �{' t/�Q _ — �` (\�\ � `, 1' �� ' ���J• �:111111•^"•�i IY � �' ``/ � � �1�.. V �'.L ��7• � o t . I-��..��.�-ao�..-r„-� ��.�.�1 7L`3���.]I.t�.�. �O�r � . � A�P �icarrt • L�cation: . � ' . � �. , . - � � . �r���.�r� � ifi . . � . _ : . . � , System Type (In Acx�rdaa�c� Wn�h Table Va�: �E� i'HiS SYSTEi�I ,.H�S F3E�i II►iSTP�1.LEi3 � Il� Ca�IIPl�1VG� 1MiN �►I?4�LlCA�i..E NOR?3-t � �P � C�►ROU�► ��EiZAL ST�'i'UTE�, RULES Ft]R S�fA�� TREAT�d1FiVT AAID DlSP�S�1L; • AI�D "AL•,L � C�l�lDlTi��IS • C�F '�'t�E 1�A�l�OV�Bd%3�iT PE�611� �4AdL1 CL)PdSTRllCTIC�N • 1�►LlTY-10 N. � • ' . • . . - � - ' � - �-907 •� � � A or�ed sr�te Ag�rn � • . ��e ' . � lnsta�4�i y: . /"[,�l ,��wt5 _ � ' Date: 7--�9'07 ' ' . � . � � . �, �,�z � _ • . � ' � � . � . . ,,���� , S � . �g � . � ,' _ � s �.; 5 � : . � . : . . . �. , � ��.��Z . ' ' . . . f _ • . ` . . .� 5�� 5$. .s� - �� . ' ' . �' � �,d ��� ' • � . : � . 1o�� A�a'�a . W��� . . •, .I—�o', - 2-!zo �.;'130 L�,�. �y o �t , , � � ��� �'�,.�� �A�S���`�� ������°' ��� 9i � �� . . T� Nia� � 3.� Pa� # 7. � � S�s�n T}�� (1'a�le Va) ,�II' • Owned�p�licant Subdivis�or� ,4ddi�essl�...ri�aiion Se�Ph2� _„_ �t � � - - - — ,., - - � � . . , - • • �ti � i�0 �Z 7'I7-67 —o �'� �/%..C'�'.�c��. ' . C�i� � Ga� / � - v? 0 ar� -� � 6 -�`�'� �' `�, t v�� � � S� - �C � -��Q- � w ,�� �l�-� .� Q r�� t Q 1; � � fs �� ��p �--�� � U u t• S'7S � ,� C�a s , / ; � ,� f S�I�-°�r S l° � o�-- f�' P-� s� �- C�fr�'% �� -�' �� �` f -�f� 5 �' � 1,,, � --Q V(d � �� � T�t GI'� pGtir �" `7' Ca �� � / -�e s s��`'. �� � � � �P `� � �� � � � �� � . � . S�� �o c�.-� �C � e��fs� /�S 1����f-- u c��� �� �� �Q�'��.: 5� �� � � u L� � � a. ;� !�� s�Q� �' �.��e� � �' � s � ,� � p�-Gt � vl lri�.2 r�' � �►,�-e i,�,ti2 S -�( c�. � ���U`e � � � �-e-_ ��- U'�� ��"s � i � � � ` f,� 0�� �+�`� � " '- ��� ��� �� � � (� �,� °.�2 C�ur�- C�.sc � h-t�,� A �7i� �'�t" � � ��� � d-�- �.c�'��,-S �- u��t CC �, �.�c �; ��.� �'�� � � �s �� �' �'7 � � �a . �