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ORANGE COUNTY HEALTH DEPARTMENT <br /> REFE4 CE NU48ER DATE PIN MAP REFERENCE <br /> APPLICANT: OWNER: <br /> CAMP CHI''STNUT !RXDC'� ��t�C�#ISDI�'1 C1 CUSDODS <br /> 4�aO4i CAMP 04ESSTl+UT RIDGE 9 C`-P±.M.PT1+10 #UNUSTPIES INC <br /> EFLA .D �1£: 27243 PC PDX S rVISS <br /> TELEPHONE: �Y - '3Q7�J" Pi7, EX04 J1C 2762 <br /> SPECIFICATIONS: LOT SIZE I ACREAGE: DESIGNATED WETLAND? YES <br /> REP-AIR EXISTING EZYSTEh� NO <br /> LOCATION I DIRECTIONS: <br /> FEE: RECEIPT: SIGNATURE OF APPLICANT: <br /> ete <br /> CONFIRMED BY PLANNER: PLANNER DATE CLERK <br /> #BEDP+3'_-- ------- DI9P0SPIL ------ GTHEP TYPE-'---Y$ <br /> qW ---- ------J..._----.....- <br /> YOU DUST INCLUDE A PLAT OF THE PROPERTY WITH T S APPLICATION. ALL <br /> PROPERTY LINES MUST BE CLEARLY MARKED ON SITE. <br /> REQUIRED ATTACHMENTS <br /> Floor plan of the proposed house or structure <br /> Site plan of the lot (8 1/2" X 14" max) showing: <br /> INTENDED house location; driveway; water supply; and excavations <br /> or other improvements. <br /> EXISTING easements; R.O.W. ; restrictive buffers; designated <br /> wetlands wells, springs, waterlines, structures, or wastewater sytems. <br /> AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION <br /> attachments <br /> i/ site plan/layout re-construction conference required <br /> System shall be installed in accordance with Orange County Specifications <br /> for wastewater System Construction. <br /> wastef low 15.00 pd type syste=1WA6 nitrification /R60 X3} <br /> max. depth stb tank FW �MIA4. ptank Z.10AIp 1. other <br /> THIS AUTHORIZATION SHALL BE VALID FOR 60 MONTHS FROM THE DATE OF <br /> ISSUANCE. IF ANY INFORMATION SUBMITTED IN THE APPLICA IS N <br /> OR WAS FALSIFIED, THIS AUTHORIZATION SHALL BECOME IN ✓l <br /> DATE 3'7-0'9'7 ENVIRONMENTAL HEALTH SPECIALIST 4 r <br /> OPERATION PERMIT <br /> attachments: ✓construction as-built, l <br /> wo' schedule.of operation & maintenance, plus <br /> # attachments <br /> contractor -Dr+.sc Quftcall _ operator o • - 5 <br /> DATE—ISSUED 9—��—��_--__— '`NV PEPL Tip ERrsgs� <br /> Dj4TE,.4PPROVE 0%l;ol HESTH, SRPE I <br /> SEE IMPORTANT INFORMATION ON THE REVERSE SIDE <br />