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PERSON COUNTY HEALTH DEPARTMENT
WELL AND SEWAGE SITE, LOCATION IMPROVEMENT PERMIT
Tax Map # A 3� Parcel # 7
Zoning Township Fc,a r 2 � vc R
Owner/Contractor r�tc.3� R� ;., � L� Date 3/�y/��
Location/Address Nw� �s� �rd ,��,zoc� .�►.« s �� RrUi.� ���'��z�
[l.�Ii cn1 4i2v ✓� c�� 2� S.R.# jS 7
Subdivision Name Lot#
SEWAGE SYSTEM SPECIFICATIONS
Repair Lot Area ��'.� a� Size of Tank iv�w ivc�o �L
SFD Mobile Home Size of Pump Tank ^1fA
Business # of Bedrooms�_ Nitrification Line y� ����' Nc'w �i
Max Depth Trenches ,zy "
Permit Void after 60 months. Permit Void if not in compliance with zoning regulations.
Permits may be voided if site is al ed q intended use changed.
Well and Septic Layout by G�
Comments: v r� � - � A^a�
J v A� S� — nl Qn�D - �'' '�
Date Installed by E, �ok Approved by ��,�Q �
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Site
Date
WELL SYSTEM
Installed by,
TIONS
ell
Approved by
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This report is based in part on infonnation provided the homeowner or his/her representative in the application submitted for this permit The
environmental health specialist is not responsible for false or misleading infocmation contained in the application The environmental heatth specialist
is also not responsible for concealed conditions on the property or for statements in this repoR that may have resulted from false or misleading
statements provided to him in the application. Neither Person County nor the environmental health specialist wazrants that the septic tank syscem will
continue to function satisfadorily in the firture or that the water supply will remain potable. c:�amipro\perrnitsam Ol/95 rev.1.0