A33 31�3 3� .� z.
� Health De artment
Person County p
Sewage System Improvements Permit
Date:2 Z�� � Zihis Permit Void After 5 Years Permit #
Owner: � SR# ��
Location/Direcrions: �' ' "
Subdivision Name: Lot #
Lot Size: � Type of Dwelling: � -' '-^'
Water Supply: Private: � ' Public: Comm nity:
Bedrooms: Z -� Disposal
Basement Basement F' � s ��,�
INFORMA N BY '
$8I1it8Ii8tt: ovmu or representative
REPAIIt: REEVALUATION:
Size of Septic Tank: —L.�,dL 8allons Size of Pump Tank: ----
Niaiticaaon Line: 3 00 � K 3'
Depth of Stone: 12 inches
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Pump
Remarks:
-------------------------
Date Well Approved: Well should be 100 f� from any sewer system
BY Sanitarian
Date Se Sy A ved: —
BY Sanitarian
CA OF COMPLETTON
Contractor. �
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Sewage System location, installation, and protection must meet state and local .�
regulations. Sepdc tank 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. Septic tar►k and
nitrification line must be inspected and approved by a member of the Person County
Health Department before any portion of the installation is covered and put into use. If
the site plazts or intended use change this permit is subject to revocation.
(G.S. 130 A-335F)
Location of sewage disposal sewage system sketched on bxk.
(OVER)
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NOTD: 1Viake sketch of installation showing lot size and shape, location oi house, septic tanks, privies, water
suppl�'es, etc. Note special problems e�cisting on lot. Write in measurements in order that installations may be located
at later date. Note location of water supplies on adj nt lots
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