A28 531'he District �lealth Deparfinent
CASWELL -'CHATHAM - LEE - PERSON COUNTIES •
Water Supply and Sewoge Disposo!
IMPROVEMi3�TTS PERMIT No
. T..�.. Gi .� I _ 1i'�? .
�Owner: �
` Location: '
t'
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V"`V`.'- - ��!Ri�PfAc�.'�' _' _ _ •
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E, COIItT3Ct0i:
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���� �f. Wates Supplp: Private � Fsublic �
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Sewage Disposal Facilities: No. bedrooms �— Dishwasher�-�Disposal,
washing machxne, other suto atic appliances '
Size of tarik: � . , � NitriRcation •line: � �.3a f
� . . _ . � E,1 . rt - . . rx
,
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Other disposal facility: �C'��D
:Water supply anZi sewage disposal facilities location, installation and
�rotection must meet state and local regulations.
Septic tank should be pumped 'out every 3 to 5 years apd 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 IiEALTH DEPAR,TMEN'r
STAFF BEFORE. ANY PORTION.OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE. �
Date approved: Signet ,
�AI13t�1LI'1�j�4 ��+5 .
Well: 11� i�^� ��M J
Sewage Disposal: - Caigne r_� ` ���"'t�
By' (Owner:or his representative)
Certilicate oi Coinple3ion '
Date Approved: �"^� B �����
Y� '
S arian ° ,.
• (OVER)
Location of well and sewage disposal facilities sketched on beck.
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