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• ♦ ♦ I , _ <br />111 113 <br />OWNER'S NAME <br />LCTM: <br />DATE: <br />Said Zakeneh <br />81A ((4)) 36 <br />4/9/03 <br />PROJECT PROPOSAL: OCCUPANCY PERMIT <br />[�] Change of Use /Other [ ] New Construction [ ] Addition or Remodeling <br />(No Building Permit) (Building Permit (Building Permit <br />Clearance Required) Clearance Required) <br />CLEARANCE EVALUATION RESULTS(completed by Environmental Health) <br />Water Supply: <br />[x] A well has been drilled and tested in accordance with Chapter 1040 of the <br />Loudoun County Codified Ordinance (Permit # 791 FW O1 ). <br />[ ] The property is served by a public water supply <br />[ ] The addition of the project referenced above has no impact on existing water supplies in the <br />immediate area. <br />[ ] Existing supply appears to be satisfactory. <br />Sewage Disposal System: <br />[ ] A permit has been issued to construct a sewage disposal system <br />(Permit # # of Bedrooms <br />[X] The property is served by public sewer. <br />[ ] The addition of the project referenced above has no impact on existing sewage disposal systems <br />in the immediate area. <br />[ ] Existing system appears to be satisfactory. <br />Building/Zoni ermit Clearance: <br />[ pproved [ ] Approved With Conditions <br />Conditions- <br />[ ] Denied <br />(Change of Use Applications <br />denied after 60 days, if no activity) <br />Environmental Health Specialist:' <br />pc: Residential Plans Review, Building and Development (if spec' conditions apply to construction of the structure) <br />