A27 54L
�.�
; �'�� . • ----
,�� The District Health Departmen#
�� CASWELL - CHATiiAM - LEE - PERSON COUNTIES
'� Water Supply and Sewage Disp�sol;
IMPAOVEMENTS PERMIT No
Date_.
� I� ��D � Owner: A -
(J .� ""`
Location: +
��� �'. R�. � � 1 . ) � ,
.
f� Contractor: � � �
� 2� � Water Supplp: Private Public _
Sewage Dispoaal Facililies: No. bedrooms Dishwasher. Disposal.
washing machine, o�i er . o tic appliances
Size of tank: Nitriflcatioa line:-
, _�
' Other disposal facility:
' Water supply and sewage disposal facilities location, installation �nd
protection� must meef 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 pubIic health hazard.
Septic tank and nitrification line MUST BE INSPECTED ANn AP-
_ PROVEB BY A MEMBER OF THE DISTRICT HEAL -DEPAR,TMENT
STAFF BEFORE ANY PORTION OF THE INST TION IS COV-
ERED AND PUT INTO USE. � _� 1�//
Date approved: ' Signe
Well: • - ""� anitari
Sewage Di§posal: Counter= `,. '`
BY, . . _ _ � . aigne
( r se n�e �
� , / .
Cezti�cate oi Completioa � _
Date Approved: � By•
anitarian �
(OVEA) .
Location oi well and sewage 'disposal facilities sketched on tiack.