A28 145The D�s������ Heolth Department
CASWELL - CHATHAM - L�E - PERSON COUNTIES
Water Supply and Sewage Disposol
IMPROVEMENTS PERMIT No.
Date �—+����_-
Owner: ��—�l-ji�`1► a +
Location: —�—
—TT��'(1 � �" �=—�,� ' �
, � ---�r �� :
Contractor: ���'�`' ! ��T�j
Water Supply: Private —�� Public
Sewage Disposal Facilities: No. bedrooms � Dishwasher, Disposal,
washing machine, other suto.matic appliances
Size of tank: -_.�1�`�;`--`.�T Nitrification line: �/�il ��/ �'
a
►•.
Other disposal facility:
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 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:
Well:
Sewage Disposal:
By:.
/�� 'r 1 , �---
Signe' -�= � ,1{,.I ,
Sanitarian "
r.
or his representative)
Certiticate of Completion ', �
.V"�- ,
Date Approved: �� BY� ' .
Sanitarian �
(OVER)
Location of well and sewage disposal facilities sketched on back.