A24B 7%�� a � � Q�-,-•� � � � " - z
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Person.:�ou #y Heal#h Depa�r#r�ent �. ..
Sewage: S�stet��:�mpr�o��me��s P+erm'it .
,
Date: ��., ��Iz Pe��i) t ti�oid ter �5 Years Pern►it.# � .
Ovv�r. !�/ %� ,, SR#
Locadon/D'uections: � ��, `,
, , �' ' /�� _
Subdivisian Nam�: �`-i �'�l' . �� l/�7
Lot Size: � . � Type of
Water Supply: �rivate: Public: _
Bedroor�s: Garbage Disposal
Basement Basement Fixwre,
Sanitui�n: �u,
REPAIR: VA]
Size of "�epdc Tank: _�/ �
Nitrification Line: 1
nepth of swne: r2 inches
Max De�tfi of Trenches:
Altemat'sv�e System: Conv. Pump _
Remark.c: A _ _� _
: i:ot #
Canmunity:
Ilons Size of Pump Tank:
�S �F�
LPP
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Date Well Approved: Well should be T00 ft. from any sewer system
BY Sanitarian �j
Zi'dtC $ gP, StiE �Pp ' r / �
i Bi $ilIll[8I18I1
I _ f ERTIFICATE OF COMP�.E'TION �
� 'Contractor. —1 : y,n � , � �
---------------------------- �t�
Sewage System location, installation, and protectaon must meet state and local �
regu]ations. Septic tank should be p�mped out every 3 to S years and shall be�maintained
by owner in such manner as �not to creaze a.public .health hazard. Septic tank and
nitrificatian line .must be nnspected and approved by �a �member of the �Person County
Health beparnnent before any portion of the installation is coverzd an8 put into use. If �
the site plans ar intended :use change this :pem►it is subject to revocation.
(G:S. 130 A-335F� Q�j
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Location of sewage disposal Sewage system sketched on back. �
(OVER)
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