A40 108�
The District Health Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES �
- �
Water Supply.and Sewage Disposal
' IMPROVEMENTS PERM�T No.
Da "" `� — � ' �
Owner: � ✓ 1 P nQ �1 Yt / (� ✓:� -� 6ti � --
Location: _ � • � �
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-� t�C,ra�r'- 1 ��P 4v) l.J
Contractor: �
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Water Supplp: Private Public ,
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Sewage Disposal Faciliiies: No. bedrooms ��^" Dishwasher, Disposal,
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washing machine, other suto atic appliances
Size of tank: �� ' Nitrification line: '�� '
,.'
�ther disposal facility:
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Water supply and sewage disposal facilities location, installation � and
protection must meet state an� locai regulations.
Septic tank should be pumped out every 3.to 5 years an3 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-
PROVEB BY A MEMBER OF THE DISTRICT HFg LTH DEPAR,TMENT
STAFF BEFORE ANY PORTION OF THE I S`�A T N IS COV-
ERED AND PUT INTO USE.
Date approved: Signei Sanitari
Well:
Sewage Disposal: Counter-'/ ,,,, P�
aignec� 4' y^� �""— "�-- ��rt.
$Y� (Owner or his representative)
. '
Certii'icaie of Completion " "" ��
Date A roved: � � J B:� �"���,
PP —��-a� Y .
anitarian
(OVER) �
Location of well and sewage disposal facilities sketched on back.
NOTE: —� sketch of installation showing lot size� jjj shape, location of house, septic tanks, �es, water
supplies, etc. Note special problems existing An lot. W measurements in order that installations may be located
at later date. Noteo�tion of water supplies on adjacent lots.
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