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� Person County Heaith Department
Sewage System Improvements Perm�
Dateill�� This Permit Void After3 Years �
Owner: SR# �-��-
Location/Directions:
Subdivision Name: �� � � Lot #
Lot Size: Type of Dwelling: .
Water Supply: Private: Public: Community:
Bedrooms: �� Garbage Disposal
Basement Basement Fixtures
INFORMA IE BY
$�1��: oµner or rep�sentative
REPAIR: EVALU T'ION:
Size of Septic Tank: ��J� gallons Size o m Tank: !s
Nitrification Line: � ' i 1►t S t/ t
Depth of Slone: 12 inches y�, �• o•� ��[�-qd
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 Sewage System Approved:
BY Sanitazian
CERTIFICATE OF COMPLETION
�
�
Contractor.
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Sewage System location, installation, and protection must meet state and local �
reguladons. Septic 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 tank and'd
nitrification line must be inspected and agproved by a member of the Person Qounty �
Health Depaztment before any portion of the installation is covered and put into use. If
the site plans or intended use change this pernut is subject to revocation.
(G.S. 130 A-335F)
Location of sewage disposal sewage system sketched on back.
(OVER)
NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water
supplies, etc. Note special problems existing on lot. Write in measurements in order that installations may be located
� at later date: Note location of water supplies on adjacent lots.
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