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PERSON COUNTY rl�ALTH DEP TMENT
WELL AND SEWAGE SITE, LOCATION IlVIl'ROVEMENT PERNIIT
Tax �Iap # �- a,� _ Parcel #
Zoning Township _
Owner/Contractor • I�Yt ate�1 -
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Subdivision Name
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SEWAGE SYSTEM SPECIFICATIONS
Lot Area
Mobile Home
# of Bedrooms
Permit Void after 60 months.
Permits may be voided if si
Well ��ci�epjj�c Layout by
Comments:
Date
Size of Tank
Size of Pump Tank_
Nitrification Line
M� Depth Trenches.
Permit Void if not in compliance with zoning regulations.
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001 227
Installed by.
Approved by
r,r� P� V�'C WELL SYSTEM SPECIFICATIONS
I dividual_�Semi-Public Required Slab
Public Replacement Air Vent
Site Approved Required Well Lo� _
Well Head Approved Well Tag
Crrouting Approved
Comments:
Date Installed by Approved by.
This repoR is based in part on infonnation provided the homeowner or his/her representative in the application submitted for this pernut The
environm�ntal health specialist is not responsible for false or misleading inforn�ation cotrtained in the application. The environmental health specialist
is also not responsible for concealed conditions on the property or for statetnents in this report that may have resulted from false or misleading
statements provided to him in the application Neither Person Cou�y nor the envuonmental health specialist wanants that the septic tank syscem will
continue to function satisfactorily in the future or that the water supply will remain potable: c:�atnipro�petmitsam Ol/95 rev.1.0
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PAGE 62
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