Loading...
A28 107�;���-m,+� � A 1764 PERSON COUN"I,Y HEAL`TH D�PARTMENT WELL AND SEWAGE SITE, LOCATION IlVIPROVEMENT PERMIT Tax Map # �2-� Parcel # i d% Zoning Township _ � Owner/Contractor Lq.,rr�( ��� Date �-�/-Q�% Location/Address�� Z. l�ll � �-�'� ���i r'• S.R.# Subdivision Name Lot# As L�a��ea . I.ayout � � � i � ��`,��eM ���, �'- J� u - � �' , � SEWAGE SYSTEM SPECIFICATIONS /y��/�%,. Repair � Lot Area Size of Tank�Ca��-1 _rl � S� Mobile Home Size of Pump Tank Business # of Bedrooms_ 3 Nitrification Line '�('�j' X3' d7 / `1� r'j$�'��� '��� Max Depth Trenches �� ' � Permit Void after 60 months. Permits may be voided if site Well and Septic Layout by_ Comments: (� �n.D,C'� . « Permit Void if not in compliance with zoning regulations. �ered or intended y,se changed. n(� Date,��1��DL Installed by Approved by. WELL SYSTEM SPECIFICATIONS Individual Semi-Public Public Replacement Site Approved Well Head Approved Grouting Approved �,,��_ Comments: Date Installed by. Required Slab _ Air Vent Required Well Lo� Well Tag Approved by This report is based in pazt on infortnation provided the homeowner or his/her representative in the application submitted for this pertnit' 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 the property or for statements in Utis report that may have resulted from false or misleading statements provided to him in the application. Neither Peison County nor the environmental health specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. ORIGINAL c:�amipro�perntit.sam Ol/95 rev.1.0 ,. � - _ __ __ _ ___. _:., _� � , -- ----s ----_--- -- --- - �1- -- __ _.. � - __ _ __ _ _ � � _ _ --- -_ _--- - - - - -___ - - - _ -- ---- � � � `�` . __ _ - _ - __. '� - -_ - -- _ __-- ----- - ` _ __ � V � � -� -- _ __---- -----._ _ ------- -- �---- - - .. �---- � ---_- -_ _-- - --- -_ _--- --- ___ ___� ___. ___ _. .._ _ ___ � Vl-- __ __ _ _ __ �� �� - -- - � - _ _ _ _ ------- 1 � v\_ _ _ __ \ _ _ � � \ _ -_� _ ___ \ \ � `__ _ _ -- ��. - --__ � � -- _----- - --� -- - � - --- - 1 �� � �-- - - _ _-- - ---------- -=--- -_ _ ------ --- __ ----------- -... ___ ( � - ---- -: _---- -�,,,� -------- _ _ - `-', __ _ ..: _ '� i _ --- - _ \ _____ _ - � - . _ n5 _ � y _ _ ________ ____ __ _ _________ _ _ __ _ _ . __ __. . .. . _. ___ __ ___ ____ __ ___ _ ___ ; =s��'� �nf . . y _ . � _ __ _ ___ __ __ __ _ _ ____ _ _ _ _ _ ___ __ ____ __ _ _ __ _ _ . _ __ ___ __ � 3' �-� _-- -- - - -- ---- _ _ __ ---- -- - -- --- -- _ __ __ . _ i - _ ---- 10� __-- --- � __._- - - - ------- -- ---- -------- -�--- - _. __ __ _ 3ag � _ __ _ . __ -- ---- --- ____ _ _ -- - - - - --- --- _ _ _ -_ __ - - -C� � � _ _ --- _5 ��- - o-� - _ __ __ __ P /� � � � --=- --s-` s ��--- --;-5- -� --'--- --- ----- ____ � � _ o �.__ __ _ _ _ ._ __ _____ __ __ _ _ _ __ � 5 . _ - __ _ -._ __ �_�.-�-- l __ ___ _ __ _ _ _ --�j _ _ _, _ _--_ ___ _____ _. __ � c�� ________ ___________ _ __ _ _. ___ _ _ __ _ _ _ _ __ ____ _ ____ __ __ �_ _ _ _ �_ r � � _ __ _ _ ��ls�---__ _ _ __ __ _ _ _ __ _ � �_ � ____ -- � l �- s(,ori c���k� � �c:� , � G � So �� , �' � � � � ��� �9 �- � . w�