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ORANGE COUNTY HEALTH DEPARTMENT <br /> REFERENCE NUMBER DATE PIN _MAP REFERENCE - <br /> rao-st�4tJ SITE EkJAL.-/IM0 FERMI 10. et1. 9s 9870-47-6422 7. 1S. . 27D "- ! <br /> APPLICANT: OWNER: <br /> 701,01 nF C!-PPEL HILL CS-+.APEL HILL TOW.0I OF ETPL <br /> 06 M COL LVE I A 'ST I OP. *IGE COUJ%iTY <br /> LlHAPEL HILL �•tC 217 4516 1016 N COLL"RZA ST <br /> TELEPHONE: 1 S'? 04APEL -HILL MC 27=16 <br /> SPECIFICATIONS: LOT SIZE/ACREAGE. DESIGNATED WETLAND? <br /> YES <br /> •'=fiR 6AP,faCE A3�. 75 NO <br /> LOCATION/DIRECTIONS: <br /> EUP ?MYS ?CtAi1 <br /> FEE: RECEIPT: SIGNATURE OF APPLICANT: <br /> 1702 <br /> 3 1?7E <br /> CONFIRMED BY PLANNER: PLANNER DATE CLERK <br /> y�L t-'i _'Ci•�Ti Ltt''i +F.#ii+l:••'?� <br /> 's'OLt MUST J;ICLLADE WITH THIS APPLIC.ATIMi A PLAT SITE PLAN OF THE PPOPERTY <br /> OR ATt 301Pc?L?.l ktT PERMIT TO IRE ISSUED. <br /> ALL PROPERTY LINES, EXISTIi+tE AJ%i 1 PROPOSED. MUST BE. C,L,EAP.LY MAPME—n ON SITE. <br /> QTTACR?"ENT: ___PLAT OF PROPERTY/PROPOSED SITE MUST SHOW: <br /> -INTENDED HOUSE E LOCATION. DRIVEWAY, WATER SUPPL Y. AND ELCA+1QTI "ti+iS OCR <br /> OTHER IMPROVEMENTS: _ <br /> -EXISTIi+tG EASEMENTS: R10-lTS-OF-WAY: RESTRICTIVE SUFFERS-- DES3CtgATC-D. <br /> WETL PP-LDS. WELLS. SPRINGS. $�ItATERLINES. STRUCTURES. OR WASTEWATER SYSTEMS- <br /> ANY PERMIT ISSUED IS SUBJECT TO REVD ATIOJ%J IF TW SITE PLANT OR INTE-NiDE£1 USE <br /> r HA%iC£S. PERMITS SHALL E£rrLAME INVALID IF s'NFOiRV.U3TILit IN T14£ APPLIGATIMi IS <br /> F.qL SIF IED OR Cl-tANGED- OR IF THE SITE IS ALTERED. <br /> THE APPLICANT ACKNOWLEDGES THAT THIS APPLICATX0N HAS PEEN READ. � IF THE <br /> APPL I C4*lT IS 1110T THE OWNER, THE AUTHORIZED AGENT. SHALL PROVIDE WRITTEN DOCU- <br /> J"SNITATZMil FROM THE OW-AER- PEP.MISSXON IS C• 1AlNTED By THE OWNER/AGENT . <br /> FOR THE OC.HD TO ENTER THE PROPERTY TO PERFORM THE NECESSARY EVALUATImiC AND <br /> I.NSPECT3OINS, PEFOPE. DURING, P-biD As=TER THE SYSTEM INSTALLATIMI <br /> SITE =VALUAT3OJ4 INFORMATION +E+►+e+F.+E+E OVERALL C-LASSXFICATIM! ,s- <br /> SLOPE 5--- TEXTUPE ��_ STRUCTURE �� DEPTH 3Q -- <br /> R,HL?R _S IKt.DP.AIi►t S EX.DRAIN f�_ LTAR -Q• �-- <br /> ,gwto�`okG TC*r GL Co.%%Je ,'ec \ SG��-�C S <br /> D.QTE 1 0 6( Em." HEAL TH SPEC. <br /> I MPPOVEMENT PERMIT ATTAC34MENTS s SITE PLAld. PLUS 0 <br /> W.«.S-s E.FLOW ----- GPD TYPE SYSTEM ----- <br /> E!tipRJK <br /> rHE WA_TS!,ATE!? SYSTEM SHALL I OT DE INSTALLED 1408. SHALL A BUILDIPIS PERMIT RE <br /> ISSUED UPITIL AUTHORIZATION FOR WASTEWATER SYSTE?t CMISTRUCTIMM IS ISSUED, <br /> C-Nk1 4Ej;;L TH SPEC ------------------------------ <br /> SEE IMPORTANT INFORMATION ON TFIE REVERSE SIDE <br />