A40 106The Distritt Health Deportment
�� CASWELL . CHATMAM - LEE - pERSON COUNTIES
Wnre� 5upply and Sewege Dispasel
�• IMPROVEMENTS PERMIT No.��
o,n� aa�pp�y: t'17VALE' ' .P12bitC
.
Sewege Disposal Facililiea: 1Vo. bedrooms ��� • Distiwasher, Disposal,
wushing machin other au atic appliances
Size oi tankr Nitrification line: � �I
Other disposa] facility:
.. -t•� ,
Water .svpply _and sewag� disposa�;, facili�ies .location, instaIlation and
=-= •protection-.must mec�t'st�te`�arii3 'local' regulations.
Septic tank should be pumped out every 3 to 5 years and shall b� main-
tained by owner in such a manner as not to create a pubiic health hazard, '
Septic tank and ni.tri8cation line MUST $E INSPECTED AND AP- '
PROVED BY A MEMBER OF THE DISTRICT HEALTH'DEPARTMEN'r J
STAFF BEFORE ANY pOR.TION OF THE INS L 'TION. IS COV-
ERED AND PUT INTO USE.
� ��1� f. �
Date approved:
Well•
Sewage Disposal:
By:
:Certifieate of 'Complefion
-Date Approved: "� � �
Counter-
aigne l����Gi������ �
rl _��.=
(Owner ar his represenfAti've) .�
Location of well and sewage disposal facilities sketched on back.
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