A28 144a
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The Distric't 'riealth Department�
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Sewage Disposal
IMPROVEMENTS PERMIT No.
Date ' t � �— �- �l
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Owner: t� �'�f� f%� '� ��M; �,ti' �' �
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Location:
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Water Supplp: Private —a-� Public
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Sewage Disposal Facilities: No. bedrooms —'
washing machine, ther aut�o�m�atic appliances
Size of tank: __I�A�.._ Nitrification
Other
Dishwasher, Disposal,
line:
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 NIEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE. ,,r :�
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Date approved: Signe!�f-�(' ',� � ��'� i' � �'_`' ��
Sanitarian
Sewage Disposal:
By:
Counter �� �L�����
signed� ���-
(Owner or his representative)
Certiiicale of Comp etion
, •
Date Approved: � B :
anitaria
(OVEft)
Location of well and sewage disposal facilities sketched on bac�.
NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water
supplies, etc. Note special problems existing on lot. Wr,ite in measurements in order that installations may be located
at later date. Note location of water supplies on adjacent lots. _4��
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