A36 16The Distr�ct Health Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Sewage Disposal
IMPROVEMENTS PERMIT No.
' . Tla4n �f' � � �
Owner: vv ,� i i �
Location:
, C
�. � (
Contractor: �
Water Supplp: Private
�
Public
U
Sewage Disposal Facilities: No. bedrooms � Dishwasher, Disposai,
washing machine, ot er autom ic appliances
Size oi tank: � Nitriflcation line: �� � X 3 �
Other disposal facility:
Water supply and sewage disposal facilities location, installation and
protection must meet state and local regulations.
Septic tank should be pumped out every 3 to 5 years and shall be main-
tained by owner in such a manner as not to create a public health hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVEII BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY POftTION OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE.
Date approved: Signe !
Sanitarian
Well: ����� � �
Sewage Disposal: Counter- �G���"
aigned �
B3'� (O ner or his representative)
Cerii�cate of Compleiion
Date Approved: — By: e � ` �-t-�--
n arian
(OVER)
Location of well and sewage disposal facilities sketched on back.
�
r
�
NOTE: 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