A40 183� _
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�: Person �County Health Department "
:e e System Impr.ovements- Permit:
Date , Ttus Pemut Void Af : 3 Years -
Owner t _ ' �� ".r%� "
Location/Direcdons:. -: �� � ,
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Subdiv�sion Name + ' ;V e r/ : ' : ` . i i,o ' _
I:ot S�ze': ` r` - - Ty�e of Dwe�ng' � t#
b,- .�, ,,,,���,�-p
�W�ater-��p�1�"�i�'�>,. -��o� �-���� o � ...�-:.�.� �
, Semi:Private � If not:Pnvate �Tax Map# �
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Parcel #' � of Water Supply or Name "of �
Supplier# __ i . .
Bedrooms: �2 Gazbage Disposal
Basement ��g� Basement Fixp�res �
�D� 1Nir ? / / � � BY �
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�wutiutatr. ��/�-p� ownec or tepresentative •'• I
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REPAII2: �;` < REEVALUATION:
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Si��of Septic Tank: ons '"'
N2L'tn'Ficadon�Line: s���`1 �I�3 �' ���
OPERATIONAL PERMTT: � yes ` no
Remarks: �
Date Well App e
BY
Date S e te
sY_ �, R D
;�-��'��'Y / V�!el: should be,100 ft, from.any sewer system
- � � � 5anita;iarl
A��..-- � I1 f�i .il/5
V�� °" � '�`R CATE F COMPLETION �
Contraetor. �
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Sewage System locadon. installation, 'and protection must meet state and local �
reguladons. Septic tanlc s}iould be pumped out every 3 to S;:years and shall be '
� maintained by owner in such manner as not to create a pvblic health hazard.
Septic tank and nitrification line -must be inspected and �pproved by a member of �,,
the PerSon County. Health Department before any .,portion of the installation is
covered and put inW.use. `. � �
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Locadon of sewa e dis sal sew e �'
g Po ag system sketched on back. �--- �--
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