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ORANGE COUNTY HEALTH DEPARTMENT 27 <br /> REFERENCE NUMBER DATE PIN MAP REFERENCE <br /> +-�?;'3�7+ri idEi.l_ vFC?1�13T 11Z�:24-'3 SE RE —6.6--—80.1 7_ 3. 13C <br /> APPLICANT: OWNER: <br /> PASS 1VIXmt e .K,E!�t iErny SCOTT PHILL IP n <br /> 7416 c4-JAPEL HILL POJgD - <br /> RALE I C+l J%JC 27607 PC BOX ;2w I <br /> TELEP"ME: $=1-4422 DURHAM PIC i 7 70Z <br /> SPECIFICATIONS: LOT SIZE/ACREAGE: DESIGNATED WETLAND? <br /> YES <br /> DRILL Aleell A19-= NO <br /> LOCATION I DIRECTIONS: <br /> I UN r V pSI?'v STATI MI RftAD <br /> FEE: RECEIPT: SIGNATURE OF APPLICANT: <br /> li= 113530 <br /> CONFIRMED BY PLANNER: PLANNER DATE CLERK <br /> TYPE ------ SIZE ------ DEPTH ------ CASE,DEPTH ------ <br /> GROUT ------ YIELD ------ LEIJEL ------ 3,LgTER.ZMJE <br /> CMITRACTCR: ------------------------ DP.ILLERi ----------------------------- <br /> RERHS-- ---------------------------- -------------------------------------- <br /> wal slnoarl 1�e. o ds s6wv4 an �idt' "t�n►v�.ri•'h, Allmor P�„i�.`• <br /> 4ekevl 11scd 1•&$-y6 <br /> We <br /> �l Vt� �o i' �S OJr'�Gw�e�1" � p'�ai� 4't/�s 1�G or.I fSor�► l�7Vl Cotiv��' <br /> DATE, ISSUED _1J_J2_9f7------ EJ(+iV HEALTH SPEC _ --- ----------- <br /> DATE,APPROVED OVED Ei%ol HEALTH SPEC --------- <br /> ---------- ---------------- <br /> SEE IMPORTANT INFORMATION ON THE REVERSE SIDE <br />