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HARNETT COUNTY HEALTH DEPARTMENT N° 1 6 0 5 5
ENVIRONMENTAL HEALTH SECTION
OPERATIONS PERN41T
Name: (owner) Xt-,~ t' r! New Installation Se "c Tank
Property Location: SR# /70-3 R(ErZA:l~~ ❑ Repairs Nitrification Line
Subdivision Lot # 2
TAX ID#.
Quadrant #
Contractor: ZMWZ~e rd Registration #
Basement with Plumbing: ❑ Garage: ❑
Water Supply: ❑ Well (Public ❑ Community
Distance From Well: ro ~ ft.
Following are the specifications for the sewage disposal system on above captioned property
of system: Conventional ❑ Other
Type Size of tank: Septic Tank: A06 _ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch !L-ft. ditches ft. ditches in.
French Drain: Linear feet
Date: _ Zt -b 3
PERM[IT NO. 9 l Inspected by:
1 y nvironmental Health Specialist
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