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Person County: l�ealth� Depa�tment
Sewage S.ystem Imprc�vernents �Permit =
Date:�� . This Permit Vpid After 5 Years Permit #�� ��7
Owner: � /.�Ou.tJ Y�» GQ -����+7,
LOC8t10 IIP.Ctio,nS' i
��es'vie �nc+� oY t h
Subdivision Name:. �l'` t,_/.���a Lot #
Lot Size: {'�� ' ,�T of Dwelling:
Water Supply: Private: "Pu��ic: _ Community: �
u�
Bedrooms: �._ Gazb ge Disposal
Basement Basement ' es
INBORMATION CER'ITF�D BY
Environmental Health Specialist: - o or � '�e
REPAIIt: REEV UATION.
Size of Septic Tank: ��cLL�-[� gallons� Size � Pump Tank: _�1���
Nitrificaiion Line: ���'� �J �
Depth of Stone: 12 inches
Max Depth of Trenches:
Altemative >ystem: Conv. Pump LPP pamp
Remazks: � . u�,y.os.���
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Date Well Approved:6���'^"'�Vell should be 100 ft from any sewer system
BY Envir en I�ealth S ecialist
Date Se ge Approv : ���(Z�%S � p
BY Environr►Yental Health Specialist
CER CATE OF COMPLETION ,.,j
Contractor. T�,ly,eL�` S �
------------------------ .—„F��-- �
�
Sewage System location, installarion, and protection must meet ; state and local �
reguladons. Septic tanlc should be pumped out every 3 to 5 years and shall be maintained
by owner in such manner as not to create a public health hazard. ;Septic tank and`. •
nitrification line must be inspected and approved by a member of the Personl Counry
Health Depaztment before any portion of the installation is coveied and puC into use. If
the site.plans or intended use change this pelmit is subject to revocation. •
(G.S. 130 A-335F)' � ,�
.. , �
Location of sewage disposal sewage system sketc ed on back. a �
��,��` �- I-�-�
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Building Additions/ Mobil� Home Replacements
Tax Map #:�7 Pazcel#:� Address:
Approval Requested for: Mobile Home Replacement
x• Building Addition G�r.�� w/�, ���--
Applicant Name: �,�.� I_�,,., ��,.�G� �Z�- Zs�
Address: Z�i �� �_..c�-�,Q�� '�.�a .
d 1�� G� �
Phone #'s: �%9- �i 3 � - �
Permit Located: _� Yes No
Installation Date: io, � Design flow: �(gpd)
Current Contra�t with Certif ed Operato� on file (�f required):
Water Supply: ✓� Well Public or Community
Wastewater system shows no visual evidence of failure on: c��t��� lv (date)
(Applicant's signature if site visit is not required)
L�, aa� ��u,� -�b �/a�;�-r -� � ' � �r--
��(•p --�t,�,,�b�.� ; N�b �jt� �-�-t ►s -�-��G •TJ��11���
Addition/Replaeemen� Appro�ed
Enviro ent H h Specialist
�
Date
R2�-��� .
Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573
Phone: 336-597-1790/ Fax: 336-597-7808 wwt�.�e:soncountv.net
ConnectGIS Feature Report
,�CC�NN��TC�I�
tiYEB HO6TING
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�isr,ac� �a-�,�N
t=� �—� 1
Person CouMy Environmental HeaNh
325 S. Morgan S�eet
Roxboro, NC 27573
25�
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337'3
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32.8 it
Page 1 of 1
Person
Printed April 19, 2016
See Below for Disclaimer
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�TICE: kecently, we have had severai users report browser compatibiliiy issues when trying to access our GIS website. Typicaliy, ihe probiem stems from users who h
cently upgraded to the Windows 8 operating system or a new version of Internet Expiorer. We were abie to resolve this issue by directing users to the Intemet Expl
�mpatibility Yew tool. This link is to Microsoft's "How To" for the tool: http://windows.microsoft.com/en-USlnternet-exploreNproducts/ie-9/features/compatibility-�
this does not solve the problem feel free to contad us at the number listed on our main page. Welcome to the Person County GIS Website. ConnectGlS has b
epared for the inventory of real property found within Person County, and is compiled from recorded deeds, piats, and other public records. Users of GIS system
>tified that the aforementioned public information sources shouid be consulted for verification of the information in this system. Person County, Mobile 311, Connec
sume no leoal responsibilitv for the information in this system. Grid is ba5ed on the NC state plane coordinate system, 1983 NAD.
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