A40 132— — --. . — J _..
The district f�ealth Deprartmeht
CASWELL - CHATHAM - LEE - PERSON COUNTIES '
Water Suppl� and Sewoge Disposal
IMPROVEMENTS PERM T No. 4
. ,._._ �!' � -. /'�
Owner: —
Location: _
a Contractor: ` '
�
Water 3upplp: Private � Public
, ;�. .
i Sewage Disposal Faciliiies: No. bedrooms � Dishwasher, Disposa
washing machin other uto atic appliances ' � � ,,� ��
Size of tank: �'�— Nitriflcation line: • r i��- n-� '
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Other disposal facility: _ ., '� ". �T�=f
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 mariner as not to create a public health.hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PftOVEI} BY A MEMBER OF THE DISTRICT HEALTH DEPARTM�NT .
STAFF BEFORE ANY POftTION OF THE INSTALLATION.IS C(3V-
E�ED AND PUT INTO USE:� �
�L` /r
Date approved• Sig e. f.
Sani ari �
Well: �-�
Sewage Disposal: Counter �,�
BY. oigned . ..
(Owner or his represent ve)
Certificate of Completion ''�
% � j .
Date Approved: ` '' s gy, �'
anitarian
. (OVEft) �
Location of well and sewage disposal facilities sketched on back.