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1962 Milling Rd Davie County,NC � � � Tax Parcel Report '�,�d� Friday, September 30, 2016 ,,...,,v �, -.-._ � ;r ; � � , ` `r�' � - � � � . � -�-,.,. .........._,._._.,-,, �r r i � � ; t , n,. `� f� J r_.., ( ,� t. �' ' ;� �� ~�� --� I� ��� ���t � � ���� '� � ... � _ � n.- .V..�. , ` `�*�, ""+..,,,, x,t;,� 1 I ,...,'"""^---�--�-..._ ' 4.� �� � )� � 4� I . . � -.-...... . ti� ....f�,u:f�Y.^-.-.. '"`� �: ....r"'."'—FyL�--[ l� �� ^- ,.`"�� E—Yt A � I ; �t •�, �i ��---�----.V._ , �,"��`r - �-�--.��r"�� � --� _.._ -=� x `� •� a`�� .� y F ,����� I � ���t � i , ,, �`n''"'� � 3 4 �' i t/ � —- ..,_ � '�_:.:.., � 1 ��;,✓" '" { �m '�/ � � „ 1 . .,� �s '�'�/ � � 3 � I "—^� � .•.:/'. � � ( t E� �`' �N � J_�r;�` ���_��-��� % 1 � �� ,f.�`" �`'' � � � � � f( `� ���� G,��t, �-'yZ �f;'�� � � I "'--4\ f -y'.-..,�..../:� �� ��''y 1; "�`t� � I �� r! i _�.v ''•t },;j �2k � � ti.��.. ;' �..�_���-- w-f�� `� I i Y" �^�� , �����r.,.:�., f; \� � � � � f � � __�� ,�� ^r�v � t I � y�mm� I +, I � t, f.,�' i � y ; � � � � �I I ,��' .,i.�,,t t � . � ,. ; � ; �'. ,: ,, � rr' � ; � �,,�' � ,. y",� �...,_._.. ��.'''�� �'� �� � ., ,: �- �.� ;', _w,�- , `= 1 � � ' ' � ��.�l W..r. "' � j ..._._.._........_....__.......................................... :. fl .,r.:- � ............ .4 /�' :„''' ��� � ' M-` ,�;,; �.� � ' I f I l.ii'� r r � �'�' �f � � �' , f �fl r ti ".~^ t ...�- .� � ..��. .�� !! _.. ..... . . .._ ._. .._-_____. ._..._______ . .._ _. ._•_.__ __ .___..�.._._.... . .... �....5_. .._.__ __ .._.... _..III WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: H600000024 Township: Shady Grove NCPIN Number: 5759566347 Municipality: Account Number: 69071690 Census Tract: 37059-803 Listed Owner 1: SNOW VON J Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 1962 MILLING ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-0000 Voluntary Ag.District: No Legal Description: 42.13 AC MILLING RD Fire Response District: CORNATZER-DULIN Assessed Acreage: 42.18 Elementary School Zone: CORNATZER Deed Date: 12/1993 Middle School Zone: WILLIAM ELLIS Deed Book I Page: 001710599 Soil Types: PaD,WeC,WeB,PcB2,GnB2,GnC2,RvA,ChA,WATER Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 415480.00 Outbuilding&Extra 62180.00 Freatures Value: Land Value: 341250.00 Total Market Value: 818910.00 Total Assessed Value: 543220.00 9�v/�, All tlata is provided as Is without warnnty or guarantee of any kind either ezpressed or Imptied Including but not limited to the Davie County� Implied warrantie3 of inerchantabliity or fttness Tor a particular use.All usen of Davle Countys GIS website shall hoid harmiess the Nn County of Davle,North Carolfna,Its agents,consulWnts,contracton or employees from any and all claims or causes of action due to np��N.�'� t� or arising out of the use or Inability to use the GIS data provided 6y this website, _... _.: . . ., ,;, .. . : . _ _ ._ _. . . �' . � �'+_ �'�;•c �'S�`�- �' � - - ; � � '' �� j� �i-'": '��. � DA1�IE COUIeeT�f HEAL�'H DEPARTRAENT � � � . -_'-; IMPROVEMENTS PERMIT AND CERTIFICATE OF COi1�PLE�'1�3� ��� *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary Sewage Systems -� �-jL�;-� P�r�nit 6�vmber Name - ; �'r�a�'' ������.�.;./i�, � %/,�,,, Date '�.-��,^��,.,� �� 7 �o �` - v _ . Locat n . �' �,�%'% �% �'�"�12��i�` - � C���. ,-' -, , :�,. . _. ..-r ;-,, — �l,,;, �,,,n�.7 i7 7 /,`i,--,s'��_.L`��(1___�.� . �J � Subdivision Name Lot No. Sec. or Block No. Lot Size�i".�.�%t House � Mobile Home _� Business __ Industry ` No. Bedrooms �.No. Baths _� — No. in Family ��'`� _ PublicAssembly Other Garbage Disposal YES ❑ NO p'' Specifications for System: Auto Dish Washer YES NO ❑ . �, ,,�' ���::�;'l Auto Wash Ma;hine YES � NO ❑ ��J���Y� Type Water Supply _. ---- ��. l C�^�? �//� ' � 'This permit Void if sewage system described below is not 'nstall d ithin 5 years from date of issue. �� This permit is subject to revocation if site plans or the inte d d s change. � �__„ , ` i �� t' �, � Improvements permit by ��'G'f� "Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by _���� �~-a�^� ' . �>>� ��� _� ,�� �" ; .y� �.._.._______-______ . 1� � C �1� � � --�- �._� _��.��:._�_ .�.�. V � �� �f _ �--��-i, � -� ~ ;�. , } l . _ - ;�� Certificate of C mo p etion��—`-��1�����=- Date `^+� ' �`�•`` _�� - 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. , ,, . .,� � ' . AFP(�ICATION FOR SITE EVALUATIOWIMPROVEMENTS PERMIT �� � � Davie Counry Health Department � ` . , Environmental Health Section 1 ��/ �q� P.O. Box 665 , �•f`� Mocksville, NC 27028 � �C>� py ✓ . 1. Application/Permit Fiequeste By A `�� �n U� Mailing Address '�% Home Phone �{/J�cE — Business Phone �1�� �� U'(1 2, Name on Permit if Different than Above ' 3. AppUcation for: C�'General EvaluaUon O Septic Tank Installation Permlt 4. System to Serve: ouse O Mobile Home O Place of Public Assembly p Business O Industry O Other O Unknown . �'fP/ 5. If hause,mobile home:Subdivision Section Lot � �=� O BasemenUPlumbing � No.oi Peopie L7 BasementMo Plumbing � No, of Bedrooms C�Washing Machine No. oi Bathrooms � Ca'�shwasher Dwell(ng Dimensions O Garbage Disposal 6. Ii business, industry, place oi public assembly, other: Specify type No. of People Served No. of Sinks No.of Commodes � No. of Urinais No. of Lavatories No.ot Wate�Coole�s No.of Showers Water Usage Figures 7. ?ype of water supply: ❑ Public O Private ❑ Community 8. Property Dimensions � � / � �' � Sewage Oisposal Contractor 9. Do you anticfpate additions/expansion of the facility this sytem is Intended to serve? ❑ Yes p No If yes, what type? •NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, ii site plans or the intended use change. Efiective October 1, 1989. Dfrections to Property: ' • �.Fs � � . Sy � • � ' � � � � � ��'� _ �� � �`� , � �� . This is to certify that the information provided is correct to the be y knowled , n �stand I am�esponsible for all charges incurred from this application. � - ,l./-� � 3 - �3 DATE SIGNATURE CONSENT� IT �VALUATION IQ�DONE Q�ABOVE I?ESCRIBED pROPERTY MUST CHECK ONE: O i. i OWN the property. ❑ 2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be compteted by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Dav1e County Health Department to enter upon above described property located in Davie Counry and owned by to conduct all testing procedures as necessary to determina said site's suitability for a ground ebsorption sewage treatment and disposal system. . 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'�'. + � ' - •� . � �DAVIE COUNTY HEALTH DEPARTMENT ' , Environmental Health Section � Soil/Site Evaluation NAME �JZ�(�� DATE EVALUATED /��' ��� ADDRESS PROPERTY SIZE �oZ�9G' PROPOSED FACIILTY ,��/�t� LOCATION OF SITE ������ �C�' Water Supply: On-Site Well � Community Public Evaluation By: AugerBoring l� Pit Cut FACTORS 1 2 3 4 Landsca e ositior► � L Slo e 7. HORIZON I DEPTH �l � Texture rou ,L .L Consistence Structure Mineralo HORIZON II DEPTH �- t Texture rou ' �' Consistence � Structure „r' Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: EVALUATED BY: LDNG-TERM ACCEPTANCE RATE: � ,�_ OTHER(S) PRESENT: � REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam� SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Finn VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure ;iC-SYngle grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralc►�y 1:1, 2:1, Mixed Notes Horizon depih - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free watet' or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901 ■�����■■��������������������������������■���/■������■����■ ■ ��■ ■�����������������■��■��0����������n\�������■�����������������0�■ ■���■�■�������■����������������� ����/�r���/�������������0����■�■ ■������■������������■���������/���■���■�����������������■�������■ ■������■���■����\������������■������������������������������������ ■■�����■���������■����■��■��������/���/����������������������/���� 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' � r � rDavie County .1�ealtfr� �e artment Fr ..�en and .�lome .�lealt 9 cy 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONEt(704)834-5985 December 3, 1993 Jack SnoM c/o Potts Realty P. 0. Box i l Advence, NC 27006 Re: 2 Site Evaluetions Ililling Road/One 42 Acre Tract Dear Iir. Snor: As requested, a representative from this office visfted the aforementioned sites on December 2, 1993. Based upon the information provided on the application for a site evaluation and after the evaluations rere completed, the sites were found to be provisionally suitable for the installation of an on- eite serage disposal system on each tract. If you have any questions, please feel free to contact this office. Sincerely, ����A,��� �� Robert B. Hall, Jr. , R.S. Environmental Health Section RH/rd Enclosure ' . ���2',.-"� . - . -� . . . " "U � �.J ��'� . . . . .,.,-T.. r� . � '�'�-'`-r` • �: Davie County Health Department - : , "� �o�►s j�s - � Environmental Health Section ' ` ;,� - , �� � � P.O. Box 848 � �' C� � ' ,�'�`,S, 210 Hospital Street O� �'t Courier# : 09-40-06 "• 1911 Mocksville, NC 27028 Phone:(336)-753-6780 ON-SITE WASTEWATER CERTIFICATION Fax:(336)-753-1680 , (Check One) Replacement Remodeling Reconnection Name: �r rld - Phone Number � ��� '- �'f��`�J �s (Home) Mailing Address: �;�„e.'�=- J� .,,�_�.�}141 �'u' �'J' r �. (Work) Email Address: � Detailed Directions.To Site: �'F�� I�'1/�-�-) l��(J � f C t-.! , �L�-S� ���,T �"��.-���-- G7� �T. �'ril... ga?C `'` G� � ��'�"' � Property Address: � �� �*('11 1 1� I pJ 4:J " � I��.��..5 U 1..,�-�� e, Please Fill In The Following Information About The EXISTING Facility: Y [�n �!- �NOc� . , T ,,. ,. Name S stem Installed Under: � ype Of Facility: �uf�` Date S stem Installed Month/Date/Yeaz : `�� y ( ) ��'j'�� Number Of Bedrooms:_`� Number Of People: �� �-� `,��. � Is The Facility Currently Vacant? Yes�,I,�io' If Yes;For�How Long? Any Known Problems? Yes � If Yes,Explain: � Please Fill In The Following Informa„�t'ion About The NEW Facility: � Type Of Facility: (�-✓ � �v � p�� Number Of Bedrooms: Number of People Pool Size:� �1 V Carage Size: Other. ,� Requested By�'� � Date Requested: �� S ignature) , --- For Environmental Health Office Use Only ��Approved Disapproved _.� ;;!7 r � /'� Comments: l, ..-� `� `;. �, !' .���� ,� � >A;s ri' �^ .,. �� ,,j j ,; ,�'";'I�. �ca �C �.,-".t,^•.,-r ,r, ,� .� , >._,_,_---'��a;,,�-�, ._!� .��-,-;�f,,�` ,�,� Environmental Health Specialist ,,�'.�`"�'.--� -��'��.��- �"'�"'T"�� �''� '"�.� �- r"'r/' � , �. ,�� Date: � � *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of time. ..�---:�� Payment: Cash� Chec� Money Order # � Amount:$ rf�j �i�� Date: 2 '' Paid By: �, �(�/1d,�� (/ Received By: � �,t�P�'I�� Account#: �j%��� Invoice#: �'%�G� � � � � Davie County Health Department �0�►s r� Environmental Health Section � ,�,, , R" � - r� P.O. BOX 848 . � � � � �„ 210�Hospital Street � - O� �'� Courier# : 09-40-06 '• 1911 Mocksville, NC 27028 Phone:(336)-753-6780 ON-SITE WASTEWATER CERTIFICATION ra�:(336)-753-1680 (Check One) Replacement Remodeling Reconnection Name:--����—_������'i�/ Phone Number 3�� !��"'���j� (Home) Mailing Address: �� ��J����� ���ZC�, (Work) Wt��K�V1 G(�/Nc Z�dZ(1 EmailAddress: I��—I�1''�'�'lcV���� cJ � '�1'�Y/���'• Detailed Directions To Site: - �; �� a � Cd� r�-F _ ����!y�,�f��i����a�4 r�ll�,ll�� , A�o c�7- ���nlr.� � ��� t�-� �� (,�f� � Property Address:_���Z.. ������� • Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: uU (� �C���� ��v�► Type Of Facility: ��� Date System Installed(Month/Date/Year): ��� Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes No If Yes,For How Long? Any Known Problems? Yes No If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: C4V�:P`� �1��iYf�. Qt�U+�/�� Number Of Bedrooms: Number of People Pool Size: arage Size: Other: ���`r � � z����� VV Requested By: "�""�� Date Requested: (S ignature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist Date: *'The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order # Amount:$ Date: Paid By: Received By: � Account#: Invoice#: � � � . , . . . Davie County Health Department ��►s I� Environmental Health Section � _� , "` ! - r'� P.�. BOX 848 .� � � � ��,5,,, 210 Hospital Street � _ _. ... O U �'S. Courier# : 09-40-06 1911 Mocksville, NC 27028 � Phone:(336)-753-6780 ON-SITE WASTEWATER CERTIFICATION 1'a�c:(336)—753-1680 (Check One) Replacement Remodeling Reconnection Name:___��� �,�` �`�/ Phone Number��� I� I —a��� (Home) Mailing Address: �b ��J ��j C��i�, ', (Wark) W L��K����C z��Z(1 Email Address:_��f=1`►'`'�'lcV����� cl �d'�1��G'• . C. �� o � C��. Detailed Directions To Site: • � � � n-F - P�r,�L) `, � �r�1 �� �l1�.,11�� , ,d1�0(.t'T z �l c-� 17f�1 i/-� �� f,��T' Property Address:_�q`Z.,. ���,����� • Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: v��� �C��1"'� ��v�► Type Of Facility: ��� Date System Installed(Month/Date/Year): ���4 Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes No If Yes,For How Long? Any Known Problems? Yes No If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: �V��i� ������� ��i��J� Number Of Bedrooms: Number of People Pool Size: arage Size: Other: ���t� � � z�/ ��� � Requested By: �� Date Requested: (Signature) For Environmental Health Office Use Only A r ved Disapproved i � Comments: Q i � .Q � � �p������r�� .�(�S .«itiJ �,� Environmental Health Specialist Date: _ ��.? _�/ *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order # Amount:$ Date: Paid By: Received By: Account#: Invoice#: ,. , , DAVIE COUNTY HEALTH DEPARTMENT , . :. ,, � ; IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION . 'NOTE: Issue� in Compliance with G.S. of North Carolina Chapter 130 Article 13c �y Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name _� ;: • . Date " o' � •,r,,, � .-.�_ � i �,+�.,i Location � ' ^ i m.._.. ,_ •-� -- _ _- _— �GV ll;�/�� Subdivision Name Lot No� � Sec. or Block No. Lot Size � � House Mobile Home _ Business _— Speculation No. Bedrooms __ No. Baths _'"��� No. in Family _, Garbage Disposal YES � NO �- Auto Dish Washer YES � NO 0 Specifications for System: Auto Wash Machine YES �j NO � l Odd��G�=w�`� �V,�Pir Type Water SuPP�Y — ,. . ----- �O��X�J!��� `This permit Void if sewage system described below is not installed within 36 months from date of issue. . ; . . ; 1 ; ' _ ,' ! ' r. , �� ,_.. , ; r' .._ , f ... i I . . . . � ...,� � ` � Improvements permit by __ �� i *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. '"i�'; _ i � .� _i � Final Installation Diagram: System Installed by %_, , S;. �%�:: ' �',' �•- � %� '` - - � ,�,, , _ ,� , r!,":;�. : ?; �� . ,.,._.,-; . , \ � �v �.i .�.-_...,._. _ .�: �� J W ' � " _�.,M._ _._ .. ',,� . _�,_.__ .�. �t I 3� , , _ =-� , � ,���1���� � ___ ����--� � ,, , , ,,, ` Certificate of Completion ��J -� ' ' ` Date` ��1->> -__ AThe signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function �' satisfactorily for any given period of time. , � , .�R, 4 �' ���'���` SH A�D ��t�Q •S��owS ' . x,: ,�. . �i� ��� � ln)OODs Wrnllnl �0"P�'�Ty � � �� l, / *' / ' ,� ��� / ' . r; � / / ,/ ,� f . ��a�l �-"� �'%y ��P� �S� --'��' '`� � 11 L�tJG �,�--- "-� , i'� ��i�. � jr�\�- �_ - tF�P�SE3� ' �•'� 'w;�� - G��,hv�� ';�,� �< <�a+�"�, _ , d 4, • � 1%'S;1t�i, r � � � 5..%�� A'` V � � � � �y�� �--�'��. �~ C____'`� ' �,r�s f i � rz ' �`�'` {°�'�� a ( �� , �� a0" + .'�-+�'�- r�": � ��� �':C > ���:'tt 4�i �i8f `�` ...."""�-�-�---.`._ � � � ., �� �t, i / � t..�'�6�F 1jf�C �'yy ,w}.�: ^er{_ � -�---..-.""`+�+r„�a ' 4p� �F{.i <„`�G..i� j tFt�",�t ` Z Y . 1at. ,� ��' � 7. _y, �I a a 44.:', � �� r� "`s`�,y �!*.yy`�� `� t1�F t i� ^t�+r�. 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". �r�ju.TcF1�`1Rr�' s I..RE.EK/�.'oP�T.'t'v L►�►E �_._._-- 1 ^-> 1/(I I L�.I Il `'. �. �i- 1 �".,�/ 1 _1 ',c`f S r�`j:y � . � APPLICATION�FOR SITE EVALUATION/IMPROVEMENTS PERMIT • , Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone.�q�q��Eg-b`�'� 1. Permit Requested By1�1R; I�las. I,�ILLIAM �, �c�s�n►we'.avr� Business Phone��la�7a3- l�H�7 2. Address 1_b/-� �AL�w�c� ��i��., 1��NsTo�,�-S,�c.c�r nl c, -,z 7/0�- 3. Property Owner if Different than Above ��Q Address fl a� 4. Permit To: a) Install X Alter Repair b) Privy Conventional x Other Type Ground Absorption c) Sub-Division A N A Sec. ��� Lot No. nN� � S�1�qAy �av� ,a��n�HrA 5. System used to serve what type facility: House x Mobile Home Business Industry Other b) Number of people �"5(P��se�;��ti �2� 8�7 ,�1ay1�QJL Cila,LLYE,� L.�fE,e) '� 6. a) It house or mobile home, state size of home and number of rooms. House Dimensions �0' x a5� PRopasE.n� �� � '��� Den w/CloseL� Bed Rooms�Z.Bath Rooms b) If Business, Industry or Other, State: Number of persons served ��a What type business, etc. �►�A Estimate amount of waste daily (24 hours) �iJi4 '� 7. Number and type of water-using fixtures: commodes�,� �t�� urinals �� garbage disposal � �R°4'05�''� lavatory 3 �+�� showers p2 �"�'� washing machine � dishwasher 1 sinks se�.- �a,rq�n+ 8. a) Type water supply: Public Private�_Community b) Has the water supply system been approved? es No� 9. a) Property Dimensions �17�•q8 ������T'��� X 1315.SS`i" x L��'7-'11 � x 95�- �5'��5-� Aczts� b) Land area designated to building site ���onE��-czca D�► l.o.af,� kNo� (���rrr�c��e y�►1i+P c) Sewage Disposal Contractor+ (�E QRRa,��� 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? y�s 1 � /� What type? �w,�-v IN I HE �uwtu.z �F L�stzs �SEE � b a,�ov� E ln� Lrar4c �t�Do i�nro.s L`c H'1c��aF 1'lOwtE. �iJ SA.ME oZr? � f}tRE f�AtT �Nltac/ �S RfoK��LY /�SS/!S�-� . This is to certify that the information is correct to the best of my kn wledge. v�" l 9�' _ ate Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS � Allow 5 days for processing � S� I��.�Efl L�-� t ,�A� Directions to property: R�EL}Nfy �1<OK1 �•10�SVIL�-E; N,G�,w,� /58' �sr i rr1,�,�,Nv R�an (SR 1600� �[C^sllT ONro /�II�.L.I N!s /�<i0� GO t�f''J�• n2. S ,�Lt IL�S O D Z/TCHK'1�9N�S CRF.F.K IS��DIs� . �RoF��`I �'oR�E.; Is ��1 L�Enr� �in,� DF �,e�/�G� �r /t'1�,a,d6�E dF �.fcEEl� b£�c�.� . i i2'�Pd�'fY � S ��lN' %� �ovz /s�GftT ��i e�e�sr fiF -sr�'£� � Y�ow� �a�-D- 7El.c.o•� �.o1�i�� �oce.��) �nl�'o SN•�Oy �Ebv� /O��Str�P. .''1Qo���rY Xoa� �Ranrat,�, Go Es t�Lon�v /1'��u,�iu v Q.o�p ?'T 7_S'8 ' �s r �Ro,.+� �Ts �`a.�.ur�t. 1n1 �H c LS Rl fJ6f.. DCHD(6-82)