A27 62�
The District Health Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water �upply and Sewage Disposal
IMPROVEMENTS PERMIT No.
' Da��j •�
Owner: _�1 �Y1Q�D✓1 l7i—�.��h°v�-��—.
Location•
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�,, Contractor: � � ��S �—"�,
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, - � Water'Supply: Private Public f�(��
Sewa e D' ciliiies: No. bedrooms Dishwasher .Disposal,
washing machine, ther au omatic appliances
Size of tank: �%� Nitrification line: �-
6���/�-� i
Other disposal facility: �� � ;C.� �
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 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-
PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE.
Date approved:
Sewage Disposal:
By:
� : � ,' �. �!' � M..'
. f ' , . � � .{,
Signe.d� " "
'-�' Sanitarian
Counter-
signed
(Owner or his representative)
Cerlificate of Completion -
Date Approved: �� B :
anitarian
(OVER)
Location of well and sewage disposal facilities sketched on back.
N : Make sketch of installation showing lot size
supplies, etc., Nate special problems existing on lot. Wr
at later date. Note location of water supplies on adja<
�1) V� , 11
a
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location of house, septic tanks, privies, water `•
ements in order that installations may be located
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