Loading...
A27 165- �, ����w���} `'o y ��c � �-�Co'd �� ``'�.u�-- _ ,� ' � � , f ��l.���.✓ �o �'j'� �".� W �'-C /��g�e�G � /�� '� i , v�f ��-�' � -�Gtox � ��%�O �y�'.� �� � � ,��( �/iS�T — �/ byf`�" ` � ��1�� ��"� /� � r.�- �� ' , �U „� S� x Z�'� . � � �, o�� � C � ��� � �� � `J., � � g, � _ �1o�pD5 f�A �D d1rC �, � � , 1,�,� �/ �, p�o 6� a.r/�J � � 7 /� �T/"���.l� i��/�'S ,,,/ G�'�L U ��/Yti't/ ����' /j/�'�v.G�' f / �/GL!'l .� ���/ �.�✓E . -- /l�� ��l� �a.�t � � �,��05�� ���. � � � �l �� 'r/�%��— � � � �� ���� � �� �� � � ��� � � ���� � � �`� �'��' ' ,� ` �.�� _ � ��e����� % D D % �i�� Lc/ r�' � �f�� /�/� ,� � �,�� �� -����=� ���` . ��� Application Date: � � � 7�3 Amount Paid: �.00�. .�D Receipt #: 27( n 7 ea-�� ����s� I�I�I�..� ��T - - -- �����-� �-' aa�aa-oaa�-+�-+� �aa.��..Il ����.11�lla APPLICATION FOR SERVICES Tax Ma #: �'2 7 Parcel #: � b � 6� �,e��F�' �83 �F L' IF THE INFORMATION 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. r^ 1) Permit requested by: (Owner/agent/prospective owner):��� r� M n1 � R_. Home Phone: 5cj� �`7 �3 Address: . Business Phone: �� �i 3�2 S� / ox �n��. �/. t� �'�� 7� / 2) Name and address of current owner: G% ��-F � c�f rY�'i}+ �%vrn�1 �f �. C'� v' �r r�-3Jo� l, � o rv .C� 7 '7 3) Property Description: Lot size: ��.� /� Township: �� �� j�' �5ubdivision: 1�2R✓�� Directions to the property (Including road names and numbers): 5' J�d2 �/f jo , . _ ... � .� �, -- ^-- ,,.� _ � �t'��Lot # v� � 4) Proposed Use ar}d Structure Description: answer each of the following questions: ' J b a) Proposed ✓ Existing _, Type of Structure: D 1� /11Uh�� iio�11P Width: �� Depth:_� b) Number of Bedrooms: �_ Number of occ�nts or people to be served: �, y c) Basement: Yes_, No ✓ Will there be plumbing in the basement?�� ����' � d) Garbage Disposal: Yes J No ✓ � 5) Water Supply Type: Private �(new _ or existing�, Public_, Community_, Spring _ �/�. Are any wells on adjoining property? Yes �/No _ If yes, please indicate approximate location on the site plan. 6) Does your property contain previously identified jurisdictional wetlands? Yes_ No / 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 STAKED OR FLAGGED. ➢ THE SITE MUST BE 62EADILY 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 roperty. I agree that the contents of this application are true and represent the maximum facilities to be placed on the r perty. I understand if the site is altered or the intended use changes, the permit shall become invalid. , Representative � / � �.3 Da PCHD, rev. 06/27/02 ���� � . . �� � �� ,��,� � � `-~1 � � � ���� IE�.�-aa-��.� ����.71 IE���11�II� T��x M��� C _ P��rce-I # � _-" S�uihclivi�s�ioio � � Ph��s�e Sect�ion Lot # - � - --r---- ---r- • - - - - - - - - - Permit Conditions: T Lo0 � F� om o- l� 1 r� an Owner or Legal Represe Authorized State Agent: -K �, � Date: � ('�-03 Date: �$'�3� The issuance of this permit by th Iiealth Department in does not guarantee the issuance of other permib. It is the responsibility of the applicandproperty owner to in s e that all Person County Planning and Zoning and Building Inspections requirements are met This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for Sewa�e Treatment and Disposal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorilx in the future or that the water supply will remain potable. Authorization to Construct Wastewater. System �Required for Building Permit) * See site plan and additional attachments (�. Propose,d Wastewater System:.lnno�a--�►v�. (�Syo rc-duc-�r�un) Type�LB�G Wastewater F1owc3Cc0 g.p.d. New 1/ Repair Expansion _ Soil LTAR: . O g.p.d./ ft 2 Type ofFaeility: <<iin�Ce. Fami �r OWc.11tn4 ___ Basement Yes �No Wastewater System Requirements Tank Size: Septic Tank: � OC7J gal Pump Tank: ►FF gal Grease Tra.p: �g Qs�°PS��� Drainfield: Tota1 Area: ��O sq ft Total Length �_ ft Mazimum Trench Depth � 8 in Trench Width 3 ft Minimwm Soil Cover: �_ in Minimum Trench Sepazation: �_ ft Distribution: � Distribution Box Serial Distribution Pressure Manifold � Specificatitons: W Ov� �� 0. c� V � Sz (��. V i �y, � c. � I c�,�5�1'u�buncc i n -�i c c� rc.�, Authorized State Agent: Permit Ex�pira ' n Date: ► I-S -O c. Cc�n�r�L�oc� C(Car 5��� � (YlinimiL.c J�II �c.td 9-S" A-ddi�iQn�.( C�v�� �y��rby5tic Date: � �"$-Q3 The type of system permittedUis Conventional � Innovative Alternative. I accept the specifications of the pernut. Owner/Legal Representative: / d 3 � Date: PCHD7/30/2002 � an ��' ap � '�' � �il 0 � = 86 - 22 - �+0 R = 50.Ob� arc = 90. �6 � N-18-34-�3-E 82_ 13� � � � � � - -_� �� � ' - � �� 1�-I �4�-1Q �=6 .�0' � arC- 5.91 � '�' N-79 57�3 -YV g ��7 I ' , � . c �,� . �` . � �=71-22-I4 R = �Q . 04� arc = 74.74� S-U9-00-�t5- W 70.00` � . �'� � � . �� d=3 R =6 arc= S-4� ������ ������ ` � � V..! � .IL .LL IEaa�n.maa,�,,,�a3m�.�tn,A I�33Ie�mAtEIla SITE SKETCH N �Tom m v cSu m n cr .Tax Map #� a� Paxcel # �� S di 's' n cavcr r.cc,K Section/Lot# o"?O I I'5 -� Authorized Sta.te Agent Date � Syate�n cnmpostents represent a�ip%ximate contours only. The contracMr mustflag the system j�rior to beginning the iristallation to insur�e that propergret�de ta maintained SC�e' � r�' SO� � � � 0 S O � W U �t a 3 � � � PCHD, rev. 09/12f 01 ���''�?� ���� �� � � � ���� IE��s�� � ��.�.]L IEIL��.]L� T�,x P�l � p� I P�:rc el T � S�uhcilivi=�ioia i , � h��s�e�Sect+i.ota'Lo�t r Applicar� �i'vJ�1 c-! ,�/eNa'��-,� ' . Location• � Ope�"a�tlOri P�i'a'ilit � � � � System Type (in Accc�rdance With Tabie Va): c . . � . � _. THIS SYSTEM HAS BEEN INSTALLED IN COMPtWNCE WITH APPLlCAB NORTH CAROLINA GEAIERAL STATUTES, -RULES FOIi� SEWAGE.TREATAAEAIT /�ND DISPOSAL, : AND� ALL' COIdDIT10NS ..OF Ti�E IMPROVEMEiNT PERMIT AND. CONS'Ft�UCT10N •AUTHORIZATION. � � � � Author¢ed State Agent .. � . • � Date � : _ .. � {nstailed By. V, � ��it�'�S . . ' � Date: /� � ��. . . . . . . � . . . � . -�. �.�....� . .. .: ..: �� : ..� . . ::. .:.:_-. . - .: _�-io��.s�a��-�.:...._._.=. �.... ... .. _ .. .�.. . � -F����.� ��� S6✓� . � - -� T��s iooz� .: _�..-- -� �. � -�.: � . , ..�.. . . sTa � � . . � ' � Y///t'��'/Lr`� 5G", . G'ro" ��,� ., . ��y^" � � Cyflo, 4 ��J�, 7ii �ir '�� i� i . /�' 3" � , �a'g " � - . � I o � e• • -��i�_ , � `�`'`--� ��� . , ,, ��� �� �z � � /z' /z' i,z., � ,� � . -�.��.��.. � ��wo �� %� v d� o�f,e �oc.� U�i� - � . Gi` � �����,��G 6� . � �i'`.l �'� � � � � �� ���� =� /`�i ��fti�� `�� �;� �� ✓ � � . , PCHD, rev. 07/29/02