A23 127- �� z
Person County Health Department �
Sewage System Improvements Permit
Date:��.�4�`This Permit Void After3Years C� ��d ��
Owner: v � � �n ��y!rh - SR#
Location/Dirccuons �� h �f� v�� �
Subdivision Namc: n Ur�✓ Lot # s ��
Lot Sizc: � Typ of Dwelling:
Watcr Supply: Privatc: Public: Community:
Bedrooms: o� Garbage Disposal '
.
Basement Basement Fixtures �
INFORMA C IE BY �— �-�
Sanit�u'i�u�: �����,�� ou�ncr or roprescntativc
REPAIR: REEVALUATION:
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Size of Septic Tank: l�b2 gall�� S�of,P� mp ��
� Nitrification Linc: i� � br�� �
Depth of Stonc: 12 inchcs
M�vc Dcpth of Trcnchcs:
Altemalive System: Conv. Pump LPP Pump
Remarks:
/�
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Date Well Approved: - - Well should be 100 ft. from any sewer system
BY Sani[arian � � %fs ����� iNf�� �'�
Date Sewagc System Approved: �� �s � S`
BY Sanitarian 'e6
_� CERTIFTCATE OF COMPLETION
Contractor. J�� �o ��S
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Sewage System location, installation, and protection must meet state and local '�
regulations. Septic tank should be pumped out every 3 to 5 yeazs and shall be maintained �
by owner in such manner as no[ to create a public health hazazd. Septic tank and'd
nitrification line must be inspected and approved by a member of the Person Counry �
Health Deparvnent before any portion of the installation is covered and put into use. If �
the site plans or intended use change this pemut is subject to revocation. y�
(G.S. 130 A-335F) t1 G+
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Location of sewage disposal sewage system sketched on back. �.Q�
(OVER)
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