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PERSON COUNTY HEALTH DEPARTMENT
WELL AND SEWAGE SITE, LOCATION IlVIPROVEMENT PERMIT
Tax Map # � � O Parcel # ��
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Owner/Contractor
Location/Address
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divisio Name ,v %�}- Lot# N/ ,q
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SEWAGE SYSTEM SPECIFICATIONS
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Repair Lot Areal•'� A C.ve Size of Tank 7 �/ .s,
SFI) Mobile Home Size of Pump Tank� /-�
Business # of Bedrooms�_ Nitrification Line �[�C��_
Max Depth Trenches �S*'� — 2 �"
Permit Void after 60 months. Permit Void if not in compliance with zoning regulations.
Permits may be voided if site is alter r m end . use char�ged.
Well and Septic Layout by � f����'�,,�ldn��
Comments: —
Date3�2�l--`IS Installed
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SYSTEM
Approved by l�/.
fndividu 7 emi-Public Required Slab _
Public_ Replace Air Vent
Siie Approved Required W � c/� ___
Well Head� oved Well . t/
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This repoR is bas in p � information provided the homeo or epresentative in the applicadon submitted for this peanit The
environmental health specialist is not responsible for false or misleading infonnation 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 ot misleading
statements provided to him in the application. Neither Petson County nor the environmental health specialist wazrants that the septic tank system will
continue to fundion satisfactorily in the future or that the water supply will remain potable. c:�amipro�pennitsam O1/95 rev.1.0
ORIGINAL