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HomeMy WebLinkAbout11-82 Adeline Farmer - Stonewall - Backfile011-8a- I 1�reberirk Toun#g {` r-par#men# of 1hanning anb P.621opmen# DIRECTOR JOHN T. P. HORNE June 24, 1982 Ms. Adeline Farmer Route 7, Box 89 .1inchester, Virginia 22601 Dear Ms. Farmer P. O. Box 601 9 COURT SQUARE WINCHESTER. VIRGINIA 22601 This letter is to confirm the Frederick Countv 13oard of Zoning Appeals' action at their meeting of June 15, 1982. Approval of variance application no. 011-82 of Adelins Farmer requesting a 66,034 square foot variance from the minimum lot area of 100,000 square feet for the construction of a single family dwelling. If you have any further questions, this office. Sincerely, Jo n T. P. Horne Director JTPH/rsa please do not hesitate to contact 703/662-4532 o<<-'�a-a_ APPLICATION #011-82 The application of Adeline C. Farmer requesting a 66,034 square foot variance from the minimum lot area of 100,000 square feet for the construction of single family dwelling. This property is zoned R-3, Residential -General, and is designated as Tax Map 55B, Circle 1, Parcel B2, in the Stonewall Creek Magisterial District. BACKGROUND INFORMATION The applicant would like to construct a single family home after subdividing a portion of an existing improved parcel of land. The applicant is requesting a 66,034 square foot variance for the subdivision. The final lot size would be 33,966 square feet. The property is zoned R-3, Residential -General. The minimum lot size requirement for this zoning district is 100,000 square feet without public sewer and water. Fee paid Application No. ()[ I— V_ APPLICATION FOR VARIANCE FREDERICK COUNTY, VIRGINIA Date of Application Applicant owner ✓ other (please check one) Name: �'_QJOA_�C Occupant (If other than applicant) Address: / Name: Address: Telephone Telephone Location //►► of property RT 7 M67 ^'9e1-11AJ,0 &AZA&A 1 J)RAJ/70e& Magisterial District %bl (.(JAU= Existing Zoning / —3 Property Identification Number Existing Use RCA/y%l7i%,�JI��/�C ssc�3�--aa1.-oat V Adjoining properties zoning ,3 A -42 Adjoining properties land use S / The person and (his)(her)(their) address owning and./or -o.cc.upying adjacent property to the property sought to be affected (are) (i:s) : (Give names of all owners adjacent, across the road or highway and facing the property and any owners across any railroad right-of-way from such property. In the event the property affected 1s situated at or within 100 feet of the intersection of any two or more roads or highways, at or within one hundred feet of the intersection of the rights -of -way of any two railroads, give names of property owners at all corners of any ;such intersection). Name — Lot or tract Mailing address �S�cu� �� Gc�. GUic.saN' 35B 8/ 87- i , box q6 Oilk Alvore-a, I'A � EDWA�eo C . Cis cLo SSB,, �Sf�l M-T 7, b SB 7 � 8�are2 IF,0 &x 3'201 I/.we . he-reby depose -and _say _,th•at •,a.11 a'f t-he ab:ave _statme-re-s and zt-he -s-tyazement ..contained in any exhibits transmitted are ;rue. 19 t Applicant m For Office Use 0.nly F Zoning Administrator has/has not rendered a decision_ If so, ---stare.subst:anae Of -,.decision: r Date honing Administrator Date of hearing: Finn The Variance sought was denie approved with th V\ :_yam w I Decision Made_ e B ARD G Z- ONTING AP EA1LS BudIding Permit # Condi-tional jJse Permit by- 29 0 QSh O 82 (0 7 247-459 �28 • i sl H I A i _B o I 7 • A2 ice— —� O I 26 • al 94 I� 9 265-i94 P 124 B•2 A b A 23: ry See 55—(A)-23 0 GO i R. 20 �+ 22 g r�...: wf (7 0 ip See 55—(A)-24 • � 12 (�1 5 13 �► 14 1 9°Eh L")236-40 o B•loll i r Rt. 7 / -�- 48A A B @ ao a2 4 e C 32 34 36 c +e 12-0 123 11 1 118 33/ ` 5 121 1 = 116 9 it 6 S g ,'S $ 119 i$ 1{4 r . ge•4r � Xirr a•`�L�* y f .. - � fi.� �i•i • �# a T �'W,Y � �i;< • } ?i 'r, 3 ^ ,.a '�• 4 t4 off. If .}` e l k + � k tw1`bar,r'�t'.�ta•4 u.• Wit. ,•.•s i�r �'..�tia vt"Y i •�ty� q�..t �T-�.. � �`��� �� �� ,•a �;kt�r}�,,4'S��: .- .s- -.r�elOj�J� - 1i :k`r.- Y� a. � :+ yR ♦fix i. �.. ~ F }., Y �. AV s- i —a�,;.ti ' 6r'*"? •�...•�a+ 1 w� lliiff.�' '?"iT Y� �� ` �,_ S a.• t.y lb q lit • x. ` t , ��• `• i � to 7 �.1 t+T<' �. `��,yc e � '?�'r -aye,.; s. '�'fi ,�4" ta"''�: ..'� '& •,s " ..• .y slI �"Jw "ter �.a�' ,rJ[�1•A��s\'• ' > r �• r 7 fit' � �- r+ '� �� ��� . �; _tip• '!�' ti.. , s',p • �'. e'er �::.� �4� is�' - � � FF � ,�. �. . A. �C r � • � yr � � ��` .. ���� .. 4., ` h •. ♦ ,•� . OA:C �c f'PE iltAe RED C)64 a 9 r` � A � Nov�1 02 r 0 �o12M�RL'd ao9y Mo22�5 , I�tU p,LTH ply, � BRUCE C. LANDES CERTIFICATE NO. 54-17-3 (A) 1342 FD LAND Sv rJow OR P-Ogmep.-Y vgkfzNc-z z_r <" S 7p4 a 549 S h / d� S / PLorb�/r 0 N 4 � N f� Q ,{ c M 4 v ♦� O J -'^ N -7 2 o w fGS ° ILG.o4 0 LANDMARK SURVEYORS, INC. DRAWN w n 54 NOTES B. L . t 8 lili� IF$+Flii Zn=lneers, Surveyors, Planners r, 0. Box 62 Midlothlon, VirEinlo 2310 SCALE T ` 40' PLAT OF 2 PAPCL-i-S OP LAND SL-�GZVEgU DATE Fog STEVE A-DES4Avr-ht.,LoCA-rE-D IN T4S CHECKED _ D,s, +z, --c Cc;7ZEDjiz1CK, C- TY �/i2GIt-j F. B. LooSG R��i181®N nATt � t�.�� �Z/` P p I made this .................. 1.2.t.h........................ ..... day of ...... .....June.. ........... ...... Dt1-9�)_ V.M. VIRGINIA in the year one thousand nine hundred and __ ;........Fifty-Se.veCi ............................. between. _Richa.rd. F........ Farm-ar and Adel ne_C. Farmer.,....his....w.ife..................................................................... of the C.Au.n.ty..of......Fr.ederic.k...........State of Virginia, Grantor, and _...Edward ... .... Jones j...Frederick A. Allnutt and Martin R.'West, Jr. ........................_........................................................................................................................................ Trustees, Grantees, as hereinafter set forth. ifttr-nwr#1j: u4zit Tftrr£aI3, the said _ . Richard F......Farmer ..and,..Ade.li.ne...C. Farmer _... _... .................. ........— .............................................................................................................. .................... have. determined to borrow .Nine_..Thousand ... .igh.t... Hundred .... _nd...no 1.00- .------------ dollars ($. 9,...00.00 ) /. 8 .............. from WEAVER BROS., INC., of Washington, D. C., and to secure the said loan by the execution and delivery of this deed of trust upon the property hereinafter described. Xntit 14rr£f nr£, tflis b££1b itzUnrjiS£t4: That the said Grantor does grant unto the said Trustees, the following property, situated in the All that certain lot of land situate on the West side of a 30 ft. roadway leading North from the Berryville Pike, approximately two milES East of Winchester, in Stonewall Magisterial District, Frederick County, Virginia, and more particularly described by a survey of Lee A. Ebert dated May 22, 1957, as folbws: "Beginning at a stake in the western boundary line of the 30 ft. Roadway, a corner to the Lot recently con- veyed to Sewell Walter Wilson, which stake is located by measuring 1054 ft. northwardly along the said bound- ary line from its intersection with the northern high- way boundary line of the Berryville Pike, also by measuring 150 ft. northwardly along the said boundary line from an iron pin corner to Clyde Wilson's Parcel "A", running with the western boundary line of the said Roadway N 10 deg. 301 E - 321.2 ft. to a stake corner in a line of the Warner Land; thence with the two follow- ing lines of the said land N 70 deg. 15' W - 50.6 ft. to a post; thence S 47 deg. 08t W - 190.7 ft. to a stake corner to the Morris Land; thence with a line of the said Land S 11 deg. 15' W - 176.28 ft. to a post corner to the said Sewell Walter Wilson Lot; thence with the northern line of the said Lot S 79 deg. 30' E - 166.04 ft. to the beginning;" and being the same realty conveyed to the Grantors by deed of Harry Shirley, et ux, of even date herewith and to be recorded in the Clerk's Office of the Circuit Court of Frederick County, Virginia immediately preceding this deed of trust. And it is mutually covenanted and agreed by and between the parties hereto, that all plumbing, space and water heating, cooking and lighting fixtures and apparatus and all refrigerators, exhaust fans, mirrors, mantels, storm and screen windgws and doors, and such other goods and chattels and personal property as are ever furnished by a landlord in letting or operating an unfurnished building similar to the one herein described which now are or shall hereafter be attached to said building by nails, screws, bolts, pipe connections, masonry, or in any other manner, are and shall be deemed to be fixtures and an accession to the freehold and a part of the realty as between the parties hereto, their heirs, executors, administrators, successors and assigns, and all persons claiming by, through, or under them, and, together with all the hereditaments and appurtenances belonging or in anywise appertaining to the above described property, shall be deemed to be a portion of the property conveyed hereby. And the said Grantor hereby represents that such articles are fixtures and an accession to the freehold and a part of the realty, and are covered by this deed of trust. Also all rentals, income, issues and profits that may accrue from said premises or any part thereof provided however, that so long as the Grantor shall not be in default hereunder the said Grantor shall be entitled to collect and receive the rents, income, issues and profits of said premises. TO HAVE AND TO HOLD the said described land and premises unto and to the only use of the said Trustees in fee simple; (� 236 3 t pi 1—Sa--V In trust in serurr tn. WEAVER BROS., INC., of Washington, D. C., or to its successors or assigns as the legal owner of the note hereinafter described, an indebtedness of .... Nine ... Thousand..R.Ight...Iiundred... and ........... no/10O.- cr.c.-.-.-.--r.-.--------.Dollars ($_9.,.800..00..) and the interest to accrue thereon, evidenced by the negotiable promissory note of the said R.i,ehard ... F...... Fa. m. er...and................. .Adeline... C.....Farmer........................................................................................................................................................ ............................. of even date herewith, and countersigned on the margin thereof by the said Trustees for the purpose of identification, said principal sum and interest being payable in the following manner; to wit: Interest from date hereof payable ............. July 1 ........19...5.7 ...................................................... , and the sum of........SIXt.y-.t.w.o...a.nd...no/.40.-.-.--.-.-.-.-.------------------------------- ..................................................................................... ($......... 62 •.00..... ) on the first day of ..... ..........Aug.us t........................................................, 19..57, and the like amount on the first day of each and every month thereafter until and including ......... June ... 1........ .... • 1977, which said monthly payments shall be applied monthly to the payment of interest on the unpaid principal at the rate of 1 per cent per annum and an amount remaining after the payment of. such interest shall be applied in reduction of 4$........p p Y g P Y PP said principal, and the balance of principal and interest shall be payable on ...... ........ July ... 1..................... 19...7.7. Said principal and interest being payable in lawful money of the United States which sha!1 be legal tender in payment of all debts and dues, public and private, at the time of payment at the office of WEAVER BROS., INC., in the City of Wash- ington, D. C., or at such other place, either within or without the City, as the owner of the note may from time to time designate. The privilege is reserved to pay the unpaid balance of the *indebtedness in full at any time, or to make one or more additional principal payments in accordance with the Amortization Schedule on the first day of any month; and also to secure the payment of any note or notes given and received in, curtail and renewal of the said indebtedness, and upon the further trust that said Grantor shall remain in quiet and peaceable possession of the above granted 'and described premises and take the profit,, thereof'toAeir own use until default be made in the payment of the debt aforesaid, in whole or in part, or in any installment of interest due thereon, or in the performance of any covenant contained herein, and upon such default being made, the said Trustees shall, so soon thereafter, as they shall be requested by the said creditor herein secured, so to do, sell the above -granted property at public auction at such time and place and upon such terms and conditions as they may deem expedient, having first given notice of such time and place of sale for at least ten (10) days, by advertisement in one or more newspapers published in.....C.OLl.ntiy............... ........ of ........ ....F r e.de.r .^.kC............. , Virginia, or such manner as the trustees may elect and out of the proceeds of such sale, after paying all the expenses attending the execution of this trust, including a trustee's commission of five per centum upon the gross amount of sale, shall pay to the said creditor secured the debt aforesaid, with interest thereon, or so much thereof, as may then remain unpaid, and the balance, if any, to the said grantor. The said Grantor covenants that if default shall be made in the payment of the principal sum mentioned in the said note, or of any installment thereof, or of the interest which shall accrue thereon, or of any part of either, at the respective times therein specified for the payment thereof, the said Trustees shall have the right forthwith after any such default, to enter upon and take possession of the above -described premises, and let the said premises and receive the rents, issues and profits thereof, and apply the same, after payment of all necessary charges and expenses, on account of the indebtedness hereby secured. The said Grantor covenants that the whole of the said principal sum shall become due, at the option of the said creditor secured herein, after default in the payment of a monthly installment of principal and interest for thirty (30) days or after default in the payment of any tax, assessment or water rent for sixty (60) days after the same shall have become due and pay- able, or upon the accrual or threatened demolition or removal of any building erected on said premises. The said Grantor covenants that the whole of the said principal sum, and the interest thereon shall become due, at the option of the creditor herein secured, upon failure of any owner of the above -described premises to comply with the require- ments of any department of any city or county in which said premises may be located or of the State of Virginia, after notice of such requirement shall have been given to the then owner of said premises by the said creditor herein secured. The said Grantor covenants that there shall be added to each monthly payment required hereunder or under the evidence of debt sectired hereby an amount estimated by the owner of the note to be sufficient to enable the owner of the note to pay, as they become due, all taxes, assessments and ground rents on the premises covered by this Deed of Trust, plus the pre- miums that will next become due and payable on policies of fire and other hazard insurance on the premises covered hereby less all sums already paid therefor, divided by the number of months to elapse before 1 month prior to the date when such taxes, assessments, ground rents and insurance premiums will become due, such sums to be held by the owner of the note in trust to pay said taxes, assessments, ground rents and insurance premiums, before the same become delinquent; any deficiency because of the insufficiency of such additional payments shall be forthwith deposited by the Grantor with the owner of the note upon demand by the owner of the note. Anv default, under this paragraph shall be deemed a default in payment of taxes, assessments, ground rents and insurance premiums or similar charges required hereunder. I PPP_PM_1_d the Veterans Administration fail or refuse to issue its guaranty of the loan secured by this Deed of Trust under the provisions of the Servicemen's Readjustment Act of 1944, as amended, within sixty days from the date the loan would normally become eligible for such guaranty, the owner of said note may, at its option, declare all sums secured by this Deed of Trust immediately due and payable. The said Grantor covenants that he will, during the continuance of this trust, keep the buildings on said premises con- stantly insured, and assigns the said policies to the aforesaid Trustees for the benefit of the owner of the note hereby secured, against loss by fire and such other hazards, casualties and contingencies, including war damage, in such manner and in such companies, and for such amounts, as may be satisfactory to the said owner of the note secured, until the debt hereby secured is fully paid, and will keep such policies constantly assigned or pledged to the Trustees, as additional security for the payment of the debt aforesaid and upon the expiration of said policy or policies during the life of this loan, to have new policy or policies, for a like amount, written on said improvements in some company or companies satisfactory to the owner of said note, and deliver renewals thereof to the said Trustees or to the owner of said note one week in advance of the expiration of the same, marked "paid" by the agent of company issuing the same. In the event the Grantor shall for any reason fail to keep the said premises so insured, or fail to so deliver the policies of insurance, or fail to pay the premiums thereon, the Trustees if they so elect, or the owner of the above -described indebtedness, may have such insurance written and pay the premium thereon, and any premium so paid shall be secured by this deed of trust and to be paid by the Grantor within ten ( 10) days after payment by the Trustees, or said owner of the said note secured; and in default of the payment thereof by the said Grantor the whole, principal sum and interest and insurance premiums, with interest on such sum paid for such insurance from the date of payment may be and shall become due at the election of the said Trustees, or said owner of the note secured, anything herein to the contrary notwithstanding. The said Grantor covenants that, should the said Trustees, or the said owner of said note secured by reason -of any such insurance against loss by fire, windstorm or otherwise, as aforesaid, receive any sum or sums of'money for any damage by fire, windstorm or otherwise, to the said building or buildings, such amount may be retained and applied by them toward payment of the amount hereby secured; or the same may be paid over, either in whole or in part, to the said Grantor to enable him to repair said buildings, or to erect new buildings in their place, or for any purpose or object satisfactory to the said Trustees, or said owner of the note hereby secured without affecting the lien of this deed of trust for the full amount secured thereby before such damage by fire or such payment ever took place. The said Grantor covenants that the mailing of a written notice and demand by depositing it in any post office, station or letter box, enclosed in a postpaid envelope addressed to the owner of record of the premises herein conveyed, and directed to the said owner at the last address actually furnished to the owner of the said indebtedness secured in this deed of trust, or in default thereof, directed to the said owner at said premises, shall be sufficient notice and demand in any case arising under this instrument, and required by the provisions thereof, or the requirements of law. The said Grantor covenants that, in default of the payment by the said Grantor of any or all taxes, charges and assess- ments, which may be imposed by law upon the said premises herein conveyed, or any part thereof, it shall and may be lawful for the said Trustees, or said owner of the note secured to pay the amount of any such tax, charge or assessment with any expense attending the same and any amount so paid the Grantor shall repay to the said Trustees, or said owner of the note secured, on demand, with interest thereon, and the same shall be a lien on the said premises and be secured by the said note and by this deed of trust; and the whole amount hereby secured, if not then due, shall thereupon, if the said Trustee or said owner of the note secured, so elect, become due and payable forthwith. The Grantor covenants that the owner of the note may, without cause and at its discretion, designate and appoint a substitute Trustee or Trustees by an instrument duly executed and acknowledged and filed for recordation in the office of the Clerk of the Court of the County, Counties or City in which the herein described property is situated. The exercise of this right to appoint a successor trustee, no matter how often exercised, shall not be deemed an exhaustion of said right. The said Grantor covenants that he will warrant specially the property hereby conveyed, and will pay all taxes, levies and assessments upon the said property so long as he shall hold the same. And the said Grantor hereby waives the benefit of his homestead exemption as to the debt secured by this deed and any expenditure in pursuance of the terms thereof, and upon payment of this debt this deed of trust shall be released at their expense. Whenever the singular or plural number, or masculine, feminine, or neuter gender is used herein, it shall equally include the other, and every mention hereof of the Grantor, Trustees, creditor or owner of the note shall include the heirs, legal repre- sentatives, executors, administrators, successors, and assigns of the party so designated. WITNESS the following signatures and seals: c e. ......... .-.11;0.. �-. ............(SEAL) rr..r,....................... (SEAL) 4 % 0 S—% LOANVM........................................ U1 0 •oaf gust o 5 Z N CL ►yc y Richard F. Farmer, et ux1.4 o E 0 a. TO °' o o O y R. Edward K. Jones, et al,- 0 d > Trusteeszw g g • . CYnt Pi � l s�� � AfA � ]• a .� L �e o •,, o g ;nv was thi; V ,.. ,. w CIO Fee . . . ........ ................. c w Tax' $............................ : ' S O tD W WEAVER OROS., INC. e 0 y )?ea11ors--Rortgage -"Bankers p, cD Washington Building, Washington 5, D. C. ►ty N Mortgage Loan Correspondent c(D c METROPOLITAN LIFE INSURANCE COMPANY (> w :. o, Revised 11-55 D 3M 'grebruirk CITOU 1tv DIRECTOR JOHN T. P. FIoRNE P. O. BOX 60'i 9 COURT SQUARE DEPUTY DIRECTOR WINCHESTER, VIRGINIA 22601 STEPHEN M. GYURISIN June 1, 1982 TO THE APPLICANT(s) and/or ADJOINING PROPERTY OWNER(s) The application of: Adeline C. Farmer Variance Application for a 66,034 square foot variance from minimum lot area of 100,000 square feet. The conditional use permit request will be considered by the Frederick County Board of Zoning Appeals at their meeting of June 15, 1982, at 3:30 p.m., in the Board of Supervisors' Meeting Room, 9 Court Square, Winchester, Virginia. Any interested parties having questions or wishing to speak, may attend this meeting. JTPH/dll Sincerely, / hn T. P. Horne Director 703/662-4532 011-Yd-1'), This is to certify that the attached correspondence was mailed to the following on June 1, 1982 from the Office of Planning and Development, Frederick County, Virginia: Sewell W. Wilson Route 7, Box 90 Winchester, VA. 22601 Edward C. Costello Route 7, Box 88 Winchester, VA. 22601 Sewel W. Wilson Route 7, Box 90 Winchester, VA. 22601 Joseph F. Hughes c/o Seymor Barr P.O. Box 32 Winchester, VA. 22601 STATE OF VIRGINIA, Adeline C. Farmer Route 7, Box 89 Winchester, VA. 22601 o n T. P. Horne rector COUNTY OF FREDERICK, TO-W,I/T� I, (,�� a Notary Public in and for the State and County aforesaid, do hereby certify that JOHN T. P. HORNE, DIRECTOR, PLANNING AND DEVELOPMENT DEPARTMENT, whose name is signed to the foregoing, dated /_ , 1982, has personally appeared before me Vnd acknowledged the same in my State and County aforesaid. 1982. Given under my hand this .d a y of . _11 My Commission expires c?-o?7-8e1 'WA �i //' , IV 011— IK;L - 13 PERMIT TO INSTALL_,® REPAIR, ❑ REASONS FOR REJECTION ❑ WATER SUPPLY ❑ SEWAGE DISPOSAL SYSTEM R (1) Void after (12) twelve months. (2) Automatically cancelled when site conditions are changed from those shown on permit. (3) Automatically cancelled should facts later become known that a potential hazard would be created by continuing installation. FHA/Va ❑ Yes :E No Date L"4 s 6_S� Case No. Owner � • S/�(� _IRE y Address ��`�- �Ox S�/ Phone "r �(r= � (Mailing Address) Occupant Address Phone (Mailing dress) Exact Location of premises >/Z-2-L- (Subdivision, Street or Road Name, Section or Lot N/) &-J L ST S •t D ,�7 FOR: Dwelling ❑ Other Automatic Washing Machine Yes ❑ No Consumption U: gal. per day Actual ❑ Potential a Bedrooms Garbage Disposal Unit ❑ Yes ..© No ❑ Actual estimated Water� Additional wastes _Q C� WATER SUPPLY (Existing) Class ` /ApprovedYes No O n Other (To be installed) Class—Cased—ft. to be grouted ft. ArcM4 7tWi~ /F /GL, c.C', 74��l3l/b UNES (U less supported b positive evidence Class III is to be considered as to be installed.) SOIL STUDY Naturally drained, suitable by sight .g Yes ❑ No Technical Classification LJ"'VXf (-1—w (If Known) O )Estimated Percolation Rate 1-10 ❑ 11-25 ❑ 26-50 Ei-151 ❑ Percolation Test Required ❑ Yes No ® Rat (Minutes per inch) Death to Grey Mottles 3C inches Surface drainage required ❑ No e_ (Minutes par inch to nearest 10 minutes) (estimate over 4 ft.) OTWER OTHER DRAINAGE HC= (3) HOUSE SEWER LINE Size L( inches. Type of material required k Y� Distance from Water Supply TSifeet. (d) DETAILS OF CONSTRUCTION Watertight Septic Tank of—C'.vACCIR Material Liquid Capacity gallons. Inside Dimensions Length feet. Width feet. Liquid Depth feet. Depth of Air Space / feet. SUBSURFACE ABSORPTION FIELD Number of square feet required- ype aggregate required - G (5) Depth of aggregate from base of tile to bottom of ditches �' inches. Allowable fall '- to 44 inches. Total aggregate minimum depth / 3 inches or more. Depth of drainfield to be 2L_ inches from surface of original ground. SS Distance from well to septic tank feet; distance from well to drainfield�} 6feet. Rough Sketch of Premises (including adjacent properties if pertinent, Showing Location of Lot Line, Buildings, Water Supplies, Sewage Disposal Systems, Trees, and Other Possible Sources of Contamination of Water Supplies, by Indicating Distances and Slope with regard to one another. _,c ( y bl �1 v e 5=y0'4;��s /D C'FrrT�7Lc SG �o to t . t � It •',�rl AC, s. 1 -3—`"` 05 l ; tZ —ell is ia; a$ i:..l i co Note: Owner or his agent must notify stallation is ready for inspection. If any Sewage Disposar System, or part there, direction of the Health Director or his agent. CONDITIONS DISCOVERED DURI above specifications require Health Department approval before being made. et Health Department, Phone 4-c--1—Y7s 7 when fin- is covered before being inspected by the Health Department, it shall be uncovered at the i INSTALLATION MAY REQUIRE ADJUSTMENTS OF SYSTEM DESIGN. Changes from Based on the above information, the undersigned recommends that this permit be issued. L Date Approved Date Signed `-ci LHS - 121 REV. 12/71 (Reviewing Authority) (San�"h or Health Director Virginia State Department of Health % f ORIGINAL