A31 14� A 0 ��4�9
��-��
PE SON COUNTY HEALTH DEPARTMENT
WELL SEWAGE SITE, LOCATION IMPROVEMENT PERNIIT
Tax Map # ��j\ Parcel # 1 a
Zoning Township '
Owner/Contractor 7'�%�'c.. ,9 .�c�.-o-,.-. Date � -/� 9�'
Location/Address /��-!� , I �" � _:�2,a�i / fr,� -�''-�'-c.z � ,.a�,�'`�
�-��� %%uy-.�) S.R.# /�.�c , / �s" 7
Subdivision Name i�//,�- Lot#
.i _ _ ,.. . . . .
��
yjrY"'�C �'Yi.�e.t! \
�� c�����
.� ► �
��� �
w��'� �
�`�' ��',��
� =x ��
As In
/ �
O ��D¢ � �O 1 i ��
�
�� �'� 7� 1 i
� � �+ 7v�4 �s
,�a� �I
SEWAGE SYSTEM SPECIFICATIONS
Repair Lot Area � 6�z,t�� Size of Tank ��
SFD t� Mobile Home Size of Pump Tank W/�
Business # of Bedrooms�_ Nitrification Line � o a' X 3�
Max Depth Trenches
Permit Void after 60 months. Permit Void if not in compliance wrth zorung regulations.
Permits may be voided if site is altered or intended use changed
Well and Septic Layout by ..L-�L ��.c-�-•�^
c� �i
�omments: � a o��, ? B�a �-ceX�� .�-
Date
Site Apprc
Well Head
Comments:
Date
Installed by.
Semi-
Installed by
��¢{e� Approved by
SYSTEM PECIFICATION
Required Slab
'r Vent
equired Well Lo
ell Tag
Approved b
This report is based in part on information provided the homeowner or his/her representative in the application submitted for this permit The
env'vonmental health speciatist 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 Uus report that may have resulted from false or misleading
statements provided to him in the application Neither Pecson County nor the environmental hea(th specialist warrants ihat the septic tank system will
continue to function satisfactorily in the future or that the water supply will remain potable. c:�amipro�permit.sam Ol/95 rev.1.0
ORIGINAL