014496353_clearance - Laserfiche WebLink

EHS '� l/,' Day ,-/� Date Time ADDITION CHECK / ❑BUILDING CLEARANCE COUNTY OF LOUDOUN ZONING/ENVIRONMENTAL HEALTH/BUILDING CLEARANCE EVALUATION REQUEST (may be completed by Zoning or Building) PIN: 014 •'AC1- e3 53 Date Received: 4 • d • a DO$ Building Permit # B Applicant: LCTM: gal 3A BOCA App. #T FSG �1�10(o DUO 1 BR App. # Phone: Owner: qA 1 Free mono Par+n ers Phone: Please Call ❑ Applicant or ❑ Owner to Schedule a Timed Inspection Type of Project: mnf-,n pt) l e �nr– 0- n+pnn0- S ------------------------------------------------------------------------------------------------------------------------------ - - - - -- ❑ Change of Use /Other ❑ New Construction ❑ Addition or Remodeling (No Building Permit) (Building Permit (Building Permit Clearance Required) Clearance Required) ------------------------------------------------------------------------------------------------------------------------------------- CLEARANCE EVALUATION RESULTS (completed by Environmental Health) Water Supply: ❑ A well has been drilled and tested in accordance with Chapter 1040 of the Loudoun County Codified Ordinance (Permit # ). ❑ The property is served by a public water supply. We' The addition of the project referenced above has no impact on existing water supplies in the immediate area. ❑ \Existing supply appears to be satisfactory. Sewage Disposal System: ❑ A permit has been issued to construct a sewage disposal system (Permit # # of Bedrooms ) ❑ The property is served by public sewer. f `- The addition of the project referenced above has no impact on existing sewage disposal systems in the immediate area. ❑ Existing systems appear to be satisfactory. Building Zoning Permit Clearance Approved /OK to clear ❑ Approved with conditions ❑ Hold Date: ❑ Off Hold Date: ❑ Denied (Changes of Use Application denied after 60 days, if no activity) Conditions /Reasons: Must meet all required setback distances to well and sewage di ?oral systems Environmental Health Specialist: Z'zA— pc: Residential Plans Review, Building Ynd Development ( ifspecial conditions apply toconsttucJionofthestnrcriue)