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A26 187
. . . ,V_ . . . ... . . . � � ��`�9 ��1 � Apnlic�6lon Date: � 1� 'O 2-- � ���Eq�� kmourt� Paid: ! .� • o o � � ���a� � - �ecEi l�, � �`�� U_ � � T�c flAa #k � ��� � ,q q3 .��� �� . ���.��� � � � �-���� � � � � ��.��� �...,..��� ��.�:� � C� � � aPQuc�noa Fo�r s�vnc�s - . SHALL BECOAIE INVALlD. 9) Perm;t requested by: (Ownedageni/prospec�+e owne�' �C . C� /C Home Phone: ,�3 � -s'4� -o zoo , Addres� o � ' Business Phane: �. 2) iVame and add�ess �f curr�nt ownec S�in E' l 3) Properly �'escripffion: Lot size: ��QE�cNmship: P-u�'� Subdivisian: Lot#: Direc�ons to the P�P�Y (inc3uding raad.names and numbers): 'f�4 KE t� 4,a�r ',� 1%'r.,y (�}l� 4) �7 ��� �-..�,--� ���.,.,. � R.�• — � Propcsed Usa and �cture Description: answer each af the following q ns: '� �( 76 � a) Proposed _, E�dstiing _, Type of Strudure: �"�� d-i v� Width:.��''Depth: b) Number of Bedroam Number of accupant�s or people fio be s�erved: �� � , c) Basemenr Yes � ifiere be plumbing [n the basement? .. d) Garbage Dispasak es � � Waber SuPPhI �IPe: Privabe ✓(new _ or e�as�ng �, Public_, CommuNty _., SP�9 _ . �-�Y �� ��Ja�9 P�Perty7 Yes,_ No _ Ifyes, please indic�e approximate locatian at the sibe ptan. 6) Does the prop�ty coMain praviousfy ddentlfled jurisd&�nai w�fancls? Yes _ No ,� PLEASE NOTE TNE F�LLOWING: ' 9 A PL/�T OF Tt� PROP�TY OR SRE PlJ�N MUST HE SllBMIT�ED WITH THIS a►PPLlCA170M: � PROPERTY LlNES AND CORNEi�3 II�UST BE CLFARLY NAR�. �. THE PROPOS� LOCAi70N OF ALI. STRUCTURES 9WST BE STAI� OR �AG�EU. • 9 THE SiTE NUST BE READIL.Y ACC�SSIBLE FOR }�Al EYALUATION BY THE HEd►LTH DE��►RT�iEyT ST�. i• here� malc�e appl'�cation t�o the Persan County Heatth Departmerrt fior a si6e evaiva�on far the cn-siie sewage disposa! sysbern fa� the abave-descnbed propeaty. i agree that the contents of this applir.ation ac�e true and represe� the ma�dmum faql�ies ta be plac�d an the property. I understar�d ifi the �iie is aitened ar the intiended use changes, the permit shait her�mc� irn.al'�d_ . - Oumer or . .. � • s _ �- pC�]p, rev.10t17101 . , . . . . . . ' ' • ' ! •- . :;��. 3 - ,PERS 1��1�.�YTY NORT�{: :CARDE,I�A � P . 3€7N' 't�l �-�x � , . _ � '� . . . ���. C���N�: �} , ER �:;�C}U�.. } � 4 r '` t � : Ci��.al '' �7.G�.�i�. � � I � J•��al�., �, ,� y � ' R 'r t , ' , , n �. ' . ��• ��� . .. . . . .. �. . � , . . .. . . . .. u e 'm �u�r��"�on an� ,i �Jota� P�bfi.' do hete� � certi� � � s . �' . .that. _n,t� �� " Y ;; ���� �c�i"t�wr� froi�i� �hat�-.' . � . . . . � a . � direction this ma;� . . � . �' '"'` � ' -s �; : an aCtual f�Id s�: # y aty.� tiiat�tt�e . S�z�rve.yor, personalty�a�peare ;, . � � . � � . r " �. �. � ..-� o'�o� �• -� s d�y ard ��acknaw� d��ti`� 3 eROF p�f e4ari:. � �:�= . . . .:. . . . _ . before .r�e� tti; . � . ° . . � ; . ^ �Yiiness t�►y :h�r�:�; :�c;t� seal4this the due ax��t:2f�z ���� :-�2 foregoin�. � , . 2.) � .� Jc�c� >y t ; �. 1983 �nstrument ���'�ttne�s m�y hand anc� . . . : ,,.Js. : •, . . _ � - � � ,��. , '�""'�d;,�': �=z4-G notarial seaC, thi�L_day. o�. . � � �� �.� .'N-� sp0"p0.e 6''` . :t . :1.,1y �� , i� 3 : . -���,�;-- � 92..a►' ` � � `f' RegEsiered'l:and �unrey:or . M • , 1�8� . � � ; � �� � £ 5 .,� . mc ior��� ir � � � .�. �B, . 4.. ^�: : : . , .• � .r � , :, ,»�►i'szti�i�• - . �. • � �� � � •� ,,•`'�,�� (.Afj�Y • � - . . . . t . . .� occ, ' :`� �,�.,' ' �'' .,�� i'�0 �` 11C -- Q. _ . ` . . � 0 , _.� .,�_h� �t�ic� '� �Y :.�o . �. .. •p , . ��: ' . � ' • ;;'h�' � . . ' � . . • • _ • � - • .�. .39� _ ` � �y p9' , •�' `, a s : � � � � :5 E A w' � , � : _Qo�'�eQ- ���, ti �� - �� ;'. .'q��; ..-. � . . ��, : �. �, � $ . : ; . � .:��E�: \`L�s. . 6 '�� , . . : pry *b . � . . � � . ���q �=2�4fi� ��� ' • : GO Q0' p�, . �i� • Q yb �0�,. � : , i � � ' '',.� .'. ' �� •SU���.'�c • , � • • • _ � 1�'' 4,6 ` � ' , ' � �� . iy !y � . � . ��,,. �yF� ••.. - ���'r . v 4��• , . '�i y: ,� Q• �, . -� ",�•s � �;. �P �*�! • • .. . , . � • i,1� ��: vm ' , . . . � .. '���11+�1n1'���' r' � y � . . .•, � . , . . . .. . . `. !L•. ; . • . . 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' ,�;. ,'� � �:'i � i � - . • . �{ {Z . �'' . , . t � � y � �.� ' � . � c �W� f f , ' . � � 0��,� . .. . J�' ` ` . , '� � J�,'� . �•0t � ' ' - � ' , . 1.►. - . ,�X � s' � � v. 0 . . ' . . . , . . : . � -�. . :�v f�� ' 1,:,` t � _�� • . �' _ •. �'•' � � ' . . _ ..�'� �0" . . '%h?�" ��,,� rtQ� �., . .' 4 , - . . ., . � .. ; . .. � . �w ' �rr% .' ��0�ti; -Y \ . i .�\� � . �r . . . .' . `� �,.' : . 5�• ��' �"_�hO A O .1 ` . O` .. : � � • � . . � • . � ` _ G.. . :' �. • � , � q . � � �av RaQb ��" .. . . .. . . .� • ��,. � � > ' �. . . ; .. � � �r. ._ . . _ �' '�a'�t.w •.,; �``t � . •. . . � t . .. . :r, �; , r • ' '' , ' • ' ' ' ' � ' �; . ' � � � . . F , ` _ � � '� . . . ' . �. . . � ��1 �, t ` ,' ' ... ' . .�: •'� .� �� . y_ 'r>:`^' . • � ' ' ' � /'. ! • , . . . - . . ; . ... . . . . _ . .. ���, ss ���.� �� `�..� c� � �T�T�`'� ��n�n�-on-n�tan.cca�n�.tn.� ����n.�.��n Applicant: �c�//�n15o►.1 `tZ _ �'_�,� �1�- Location: �� ��,��� �, � � , �,_,,,� � . Ta�x M��� : - Parcel u � s��n����.s��o�, PMas�e Sect�ion Lot � Improvement Permit Permit Valid for ✓ Five Years No Ezpiration • Type of Facility: v New ✓Addition Water Supply # of Occupants # of Bedrooms Projected Daily Flow � g.p.d. Proposed Wastewater System: Proposed Repair: ^/�/ c�/r�;,,L,,a '- .�� � t� � � '� /i ' :i , r ./ r /Lr"L __� Owner or Legal Represe Authorized State Agent: Type: �'TT_ Type: Date: � /?-f9 �- �, - Date• Z-�� oz The issuance of this permit by the Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicandproperty owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are met. This Improvement Permit Is subject to revocatlon If the site plan, plat or the intended use changes. The Improvement Permtt is not affected by a change in ownership of the property. This permit was issued In compliance with the provtsions of the North Carol3na Zaws and Rules for Sewage Treatment and Duposa[ S stv ems, (15A NCAC 18A .1900). ' Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments (_ j. Proposed stewater System: �/►�G��ia,t/.�ie Type�� Waste ater Flow �.p.d. New .� Repair Ex ansion _ Soil LTAR: d. g.p.d./ ft 2 Type of Facility: Basement _ Yes �/1Qo ____ Wastewater System Requirements . - � . . • .� . • . � . . � _ ' � , ' ' • " ' . ?%��li�i'� . � � . . . �``. � . . � "' . . . � � . ��� � � ' _ � . _:_, . .. . . - . .. . . � . . • . .. .` -.• ''_�" •.•,. . . •.-:. • '� . ' . .�� �: =r, ri•f- ' . • . `.'. •'� • - • . � � . ' • . . '- �� . . � . . � � :��� S� � `' �.��� � � : , a . - _ . .`._! : � . . �' - ,. .. � = � : �„� .. .- , - . ; .c• ♦ �::- mm- ���T�'� � _ : '�,�b . ;Jr�:y:_ , ., •�`... ,;.,. ����-� � .. . Gti � _ . - : : ; .;�- - : � . . . . . � � '''"'., '• : a'.�.�`: . , i� : :. . . : SI1'E SK]ETCH . • : _ ��,�''`° !-- � . ; ,� ;� . . Y �j 2 , Tax Ma.p #��.Parcel # . ' �..:�� �'9� t0 - ' � . .• _ . . . . . . � � �. Name �v,/A �•�-�� � - G' i�— �•t� ' - . . - . . . � _ � � Secrion/Lot# '' jK' � Subdivision �� "� ' � �, W -"'� . _ . - :. � - � ' . . ' . - � Date � ' �_ -'"� .' � :' ' � � = �.' '�'•. '�4: � . • , . . , Autho e e Agent � �{� �• . � =:� - .� � ` . - ' �j'� . . ' . . ' _ . � _• � �' +r^ •� `�• . . • ` � �•• . ' • . , . . �� The contractor must, flag t1u system pnor to � - �; • ' System components represent approxima •contours only. . h, • ;- .. �.�' . :.. . • . • ' ' . . - - . . grade is maintained • - '• ' ' �~ .• " beginning the installation to insure that pro�ie�' ' '- . • - ' ' � . . '. _ . : _ - - .�, �� ' �! - v • , '" � �'-• � .. $nl�/ ¢��ra�/s �0�/7.;,c! • ' � `�. •: . . . -J � � �" � i' . '' + � � . � °1 � � �_ , . . . i��- a�'/o,��Gr.�f,�� .r- = ' ' . � . - R Q . � - . - �' � -. • V - .� � � . . • ,�6' .s �s��-���o � . . . - � �;,: . _ . _. t� � .� �, ` �� .�,� , _ _ . �-��, �•,..'. . � . - �: � .�- .� .� � _. �BD.� - ; : . _ � ,3 z` - i � :. �� - - :�Z�� ��s��"a � `'.' . _ : �". . . . . . � 1 . � �. ��' . . d�� � .. - q - �.:-. � . ' �ti: : �. � �. �� _ �:�3 � ��r ' a.• .. . . � � . . .. • :s � . ; �f� : '. � ` . , : . . . - ---- :4 - � p� � .i� :�. ' - - . ,9�i'�� , , .. ' � - � . . ►• . . . �+ � � � � p ��`'� t . � . /� � � •�7•�. _ • _ ' �It11MJM �JS� � � . . . ' - i�. •�' i -� � �{�� Z� . - � . . . .. �Ts�►G�L' �M ��' 3�� ��' � � � �%, ��ST . • - . .�►,�. . - Z �~ �I , .. ' r � A�1D �£1.1+ � , " U `{ - _'�►� `• • 1 �' - . . .. . . �T � u� - = �,' '� - . . . � Ic eo !d� � � , . . ' '• � - -�''�+.'� 1. � . � • �� ; �5{� ��,�� ��T`*�' �' 'fi . �, :. :'� �' � ' ;�• � � ' �n, �v�i�.�-T�oef � �. lo' � ��� oN -�e �4 i�C�'`A ' • ' ` � ,' `r :� � �� G f !D' �atil � i � Co�/�av�e. �C� 7���4� - . : - . � �'� �S � . � . . �U���� o� �N ��D. �-s,�c �, $d t� � � " � � � N �c1 • Y � � s , . . .: � • . � �d , � . �� - � � 'i� � , '�'' ;. �� ! % ' L ti�. � , �' � a �� s �� . - _ 0 R1 - .. ���� i � � �� �• ;��,.g j �- _ _ d.✓ f,'l.iD ' • • . _' . . � .�f �` �,�.�,�r � . ' N � � . . �4///Y///-�vMt� ' /; ���� �' i �� • � . • • A ~ . �?�� � ~ !'I / . . � 't7Sas74P��� ` ' . � _ � ' � �1fr` � . �. _ k' � � Scale: � � � _ _ '� �� ' � • ' �� .,t _ '� � •':� . • .��, .� • . `QoArD _ �`a, � . ' . , .. `��7 �... '� 9f �� ' . . , � �•,-• .j,,,�'�. ~�'• �1 � � ��p i. � � I - .... . ' • ' . �i � � � �` i-�"hA� ' �� '�/ ��� . � i' � ' � • . . i. . . . � _ � � • • • ' . ` I • , ' • . • . . , . a i� . .. i � , . . . . , ti , . T. - . . -- . .. . . - � :�-�-gf•�l4`X,.. • ,_ . �,, . - . 3 � . .. . � . . _ _ -. . . . � ��.���' i � � ��1�0.� �� .. � � . • �,,,,., ',.' "' /� [�'� �y% ' . ~ ' �'^ . `l..s��`�1�f�J �i�7`�y •� �L. ... . -' - -'- -. - . -.. . . . . . . �r.']ta.'�*7t3`ammm iemm �8ffi��.L. ll 11i�.�ID.JI� . . Tax Map #: �� � . Parcei #: � � � Zoning: Township: ' . Subdivislon: � � � � Section: Lot: Appltcant:5�"�� �5� � � �C �c..� Location• 3S3 � (Yl o�'-Eo/� P�� (( Gt m�� � Operation Permit System Type (In Accordance With Table Va): � THIS SYSTEM HAS BEEN INSTALLED IN COMPLIANCE WITH APPLICABLE NORTH CAROLINA GENERAL STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, � AND LL CONDITIONS OF THE IMPROVEMENT PERMIT AND CONSTRUCTION � A H RIZATION. - - .7_I8"�a ' Authorized State Agent Date ■ ��5,� 5 � � � �02- q�-((r ,, � 1�� �,s� e�y31 g�' g'q'IL �„ `� ���iti ' �,�� � /� �� � V �, q��'�a �i' ��� � �c �YL ` ��3 9 ' �o f �4 l0` Z Z� I � 1 S� � �� � �.�u - �s � 3s .�tnc.� — � � � , _ . � ,..: • .. . . �j�pi� .',:h . . . , : - : �.+���=a� . � � . -, _ - ..� . . .. - ... . . � . . __., . . _ .. . . . �-... . . . � . . = . ~ . ,. ' '� . . ... - . • . " -� • ,' , • . . . ' ' . 't I � �t, . . � - , . - � , •��� • • �,� . . 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