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PERSON COUNTY HEALTH DEPARTMENT
WEL AND S$WAGE SITE, LOCATION IlVIPROVEMENT PERNIIT
Tax Map # "� 2 Parcel # �'� � � ,`
Zoning Township ; � �
A 1429
Owner/Contractor �ICS P k Date '"j -/ la- y�
Location/Address LI-Q ;5 T/�? !-�� 5 1-�,rS ��-r�, '� • � JOS
S.R.#
Subdivision Name Lot#
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SEWAGE SYSTEM SPECIFICATIONS
Repair Lot Area Size of Tank � X; ��-� Y1Ct�
SFD Mobile Home Size of Pump Tank 1V)
Business # of Bedrooms 3 Nitrification Line � '
Max Depth Trenches '
Permit Void after 60 months. Permit Void if not m compliance witn zorung reguiations.
Permits may be voided if site is alte or ' ended us ch
Well and Septic Layout by
Comments:
Date � -� - Y�i Installed by,
Head
omments:
Approved
WELL SYSTEM SPECIFICATIONS
' Semi-Public Required Slab _
Replacement Air Vent
Required Well Lo�
We1�Tag �
.
Date Installed by Approved by
This repoR is based in part on infortnation provided the homeowner or his/her representative in the application submitted for this perntit The
environmental health specialist is not responsible for false or misleading infoRnation contained in the application The environmental health specialist
is also not responsible for concealed conditions on the property or for statements in this report that may have resulted from false or misleading
statements provided to him in the applicatioa Neither Person County nor the environmental health specialist wartants that the septic tank system wiil
continue to function satisfactorily in the future or that the water supply will remain potable. c:�amipro�pe�mit.sam O1/95 rev.1.0
ORIGINAL