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A25 27-,�-,�-s z � Person Cour���� H�alth Department � Sewage System Improvements Permit � �� This Permit Void After 5 Years 4 Date: ���1 SR# �33L- Owner: . x . .. Sulxiivision Name: /��� Lot # N/�1 Lo[ Size: Z� Type of Dwelling:�'���'v% 8��1d %�►a Water Supply: Privatc: Public: Community: � Bedrooms: N�� Garbage Disposal �10 Basement Na � Basement Fi es No � �%� INFORMATION CERTIFIE BY � i�a-�-1/ � - $�1��: pa� a. ��,�, own r or repres� REpAIR: EVALUATION: Size of Septic Tank: /U00 gallons Size of Pump Tank: Nitrificauon Line: �Oc� x 3' Depth of Stone: 12 inches l2'` Max Depth of Trenches: IS�� Z�i'� Alternative System: Conv. Pump LPP Pump Remarks: i��c Tewk b�zs�d�., bu����Na. Ssl,. 80 �pp�oY. v�. 0 z Date Well Approved: �- /3-93 Well should be 100 ft� from any sew�r system 3 BY . Sanitarian i,/�// �J� b i��.A1�. Date age Syste Approved: /-/3 '- 9 3 ��'�+��''� _ BY � � Sanitarian alc�r. �y �+� � CERTIFICATE OF COMPLETION usz.d . � Contractor. ,i l�. �v.� S�ca�'�/� ------------------------- � Sewage System location, installation, and protection must meet state and local '� regulauons. Septic tanlc should be pumped out every 3 to 5 years and shall be maintained � by owner in such maziner as not to create a public health hazard. Septic tank and'� nitrificauon line must be inspected and approved by a member of the Person Counry � Health Depaztment before any portion of the installation is covered and put into use. If the site plans or intended use change this pemu[ is subject to revocadon. � (G.S. 13U A-335F) � � Location of sewage disposal sewage system sketched on back. fV � (OVER) � N� _�: 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. � � o �1 ` �i� �I . � �z� I o_� : ,—, �. � 8 w r��plicationL�te: � oZ-6� r�mount Paid: I 6. D Rec�iptY: a � _ Tax l�Iap: � __ _ Farce: n: ��� 7l � �---`--``��,.�-. I�� : � J �� � `_. � � �CO ��C�7�s��y-. ��� ��. " TC✓ `S71'iti"':i S K} 1tZ:2Y,YA K i �.> �Y.'..: A. 11. 14 Jl K'�s •CS3. :1 ��Z l�p��ic���o� ��r �e�ie�s (Septic Syster�s and W'ells) Se�ic�s Rea�uested � ImprovemenCPermit (Site �valuation) S244A(�I�300.00 (if> 600 gpd) t'VZobile Home-�3eptacement or 8viiding Addition �1�O;Q0 (ifsite visit required} C �,'V�i13'ermit (New/Reptacemen�llftepair} ��oo.oai�2oo.aoi�7s.00 � ) Services Reques#ed �y: Name: 4� � �.1� x=-�� Address: � ,� � �, c�.- ..i�K1�.s � c;f�.�S 2}I'tans� ae�d addr.ess aF curr�nt awner � Name: Address: p Consirvction iluthorization (�ee is dependeui on the #�oe of `'J Permit Revision 7 Repair af Ex:siing Segtac Syster�t No Char�e ��,.-a t t'��. u l�� EC-� �n z r-� �,l Phone �(home): � i�i y t� �— 5�.��. c� f j � (�vark/�oe�-}: �a i � � �I G - ,�' `/ �"9 tt�ata a�piicant): t�p���x. �) �roge.-ty �escript5om: Lot Size; 1 �Jt� ��c� Subdivision� � � �,ot #: �� Address and/or directians to Praperty: �/ �� �" '( c���. .i i c n S r t� . 1 3 3' 4} �'roposed Use and Type oi5tructure: ; ! R�sidential BusinessJTyge: � � ►` � E,'F' ` �fiher Number of bedrooms N 1� I�Tumber of peopte served ( eats/ernployees}: � Basement: Yes � IvFo � (ti�tth plumbin�;. Yes No __} Garbage disposal: Yes _ _ _ No �_ (j j r� . � i�it` t.t e1 �-'� �'�i�'" 3 G` 11 t%� i+ti 1 i I b'`Z ��E' C( li` 5) 4Vater Suppty: � C3 4 t�i. � c; �� w• �a cr n r��-c� c` =1 si i� C.' �%r� Private 1�ell � (Proposed Existing � ) P � � �, 4,�,� � j v �; � � �.` Community Rrell: �'ubl'zc Water System: . Are there wells on ihe adjoinrng properties? No ____ Yes � (please show location on sife ptan) ote: A completetl aanlicatiun must asa`i�xctude: /V �# . �.v� ; �-� c.; t:s � i r �. ,: �,`r�� �, � .�,�cr �s f : c� � �^ r`t� �,9 �lat/site �lan af th� prot�erty td:ut slcows property dir:aensions a�d the siz� a�id �ocation af �11 .�r`z j�, �roposed struciures. ' S A�ibned capy vf fli� `� at .�'re,��r �tio}a'_,,f'arm ver��i�s; ihnt �1ae,�Yapery is �e�r�y io l�e. evt�luaiesi. � ��¢z stt�mitting #I��s ag�tildcatinn io re�vest servic�s fram #4�e �'?rson �ountV✓ �e�lth �ega�tpne�t. � �nc�erstaud that i�'th�e im,air;natic�n �ravide�3 is imcorx. �# oa� ii t4�:e site :s sut�s��ue�nily alterec�, or ��'t�A intend�d us� cbarges, a�l pers�nets and appra�als shal� became invalid. ; � � � ^ - s?g*��d�rp (Cwne:lLe�al ReprPsentative): �aiE . �5 � 8 20„�, l0i�g P.rsen Co�anly Lnriron�ze�ta? �?�alth, �?5 S. �i�orzan 5t.; S��i�e C, R�xboro, NG 27�7� (;3�-��'7-1�40) � I_ _ - - - - -O- - �- -. - - - - ..,.... .y . \ . ��.. .�� . . ��� . � .. ���. �. � �. _ � � � � .� : �. � . . � � .��. ��� . ���. . .. _ � .. . . . . --'-�-t — . �4. 3 � I ,/ � ^ � g� , -h , , � I " I •� T_'__ � _ _�_._ _ �M � � ! ti°� �.irar; � . . , � . � . . . . � . . . . �� . � 1 M1 � � ' furv�za q� q � -- � � ���" : . ,.� _ . � �� � IDH1/ � rt . ] . .. . . � . . � ` � . � . . � � . . . . . . . j i _'' "'� \ ' •'_-r- � � . e . 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