A31 106�_�.. C.�.ro 1 �aw�.&e�c�
Person County Health Department
Sewa e System Improvements Permit
Date`��_�j'�*�t ermit Void Af r 3 Years %I
�WI1eI: � rf�-f 1�ri �����_ �� i l�4�J��%% �
Lot Size: � Type of Dwelling:
Water Supply: Private: Public:
Semi Private: If not Private Tax Map#
Parcel # of Water Supply or Name of
Supplier#
Bedrooms: Gazbage Disposat�
Basement 1 Basement Fixtures
INFORMA N C�R�FIEJaI BY _ (
or
I..O[ #
�
REPAIR:�'` � .REEVALUATION: �
------------------------- ;
Size of Septic Tank: �Crl gallons � �
Nitri�cation Line: �� �'
Depth of Stone: 12 inches v�
Max Depth of Trenches: 3 O'`
OPERATIONAL PERMIT: yes no
Remarks:
Date Well Approved: ��- � 6'L% WeL' should be 100 f� from any sewer system
BY JBIIiL�7aR J
Date Se �� Sy,s cr� A�proved�_ �� .� a•�
BY � �,Y � t'y (7� , ._ �1T Sanitarian
Contractor.
TE OF COMPLETTON � �
------------------------ �
Sewage System location, instailacion, and protection must meet state and local �
regulations. 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. �
Sepdc tanlc and nitrification line must be inspected and approved by a member of
the Petson County Heal[h Department before any portion of the installation is �
covered and put into use. —
i
L.ocation of sewage disposal sewage system sketched on back. �
(OVER) �
r NOTE: Make sketch of installal'/i2S
supplies, etc. Note special probl�i�fs
� at later date. Note location of watJ
—4
(1)
IS
� � � � � � � � .�S/
/ lor�j� size and shape, location of house, septic tanks, privies, water
�i�o% Write in measurements in order that installations may be located
on adjacent lots.
2`� (2)