A27 885
C G� � � �o
/�� i�� �� � �e li��rV � j�M�� A 001207
� �l.
PERSON COUN Y HEALTH DEnARTMENT �
WELL SEWAGE SIT'E, LOCATION IlVII'RO�'EMENT PERMIT
Tax Map # �` Parcel # � �
7oning_ Township
Owner/Contractor � Date - 1 d- cf r1
Location/Address '� S'S � l, �•�d7��, � �.�1
Subdivision Name
Lot#
S.R.#
- �Yo�c
� ���
� ,-,
,s
�,,,,''c ..,.
.� NJ �.,
,
�i _ _ _ ;) --� -,
� t� ►�►e � . f�'"t .' �--�
;
v�
� � ���
� `-
.�
� -
� �- � l� ��
►3�� i� �3�6 � �
SEWAGE SYSTEM SPECIFICATIONS
Lot Area Size of Tank� �'' e c� �
Mobile Home Size of Pump Tank NIR
# of Bedrooms Nitrification Line f►a ��(� U 7C 3` S�z,•�� o� ��
Max Depth Trenches
Perrut Void after 60 months. Permit Void if not in compliance with zoning regulations.
Permits may be voided if site is altered or in ded use ange .
, Well and Septic Layout by
Comments: _
Date � --
Site Approved
Well Head Ap�
Grouting Ag�i
Installed by.
Semi
Date Installed
, Appruved by.
SPECIFICATIONS
�qfiired Slab
Air Vent
Required Well
Well Tag ^
Approved by
This ; eport is based in part on information provided the homeovmer or his/her representative in the application submitted for this pemut The
environmental health specialist is not responsible for false or misleading information contained in the application. The environmental health specialist
is also not responsible for concealed conditions on ihe pmperty ur for statements in this report that may have resulted from false or misleading
statements provided to him in Cie application. Neither Pecson Cou�y nor the environmental health specialist wazrants that the septic tacik system will
cor.ti�!�e to fundion satisfactorily in the future or that the watcr supply will remain potable. c:�amipro�pennitsam 01/95 rev.l.fi
.l , i
• t
�r�
/ �e,6� �-1 g�
1 �,� ,
�
Q