A28 61; �Y �
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The �istrict He�al�h Departr�enf
CASWEL[. - CHATHAM - LEE - PERSON COUNTiES
Water Supply. and-Sewage Disposal
IMPAOVEMENTS PERMIT No
_ ► � �-��--_—
. ate.�.
_Owner: �L��i�(3�1f.�.. ... �r�r ��3i3'!`�'Ac�
- Location: :�
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,: .
Contractor: —� � � j � �
Wates Supplp: Private -- �°� Public _
Sewage Dis o Faciliiies: No. b,edrooms � t sher. Disposal,
_ . .: _. , .. ... .. .
wa. �n TMachi other automatic appliances
Size. of tank: � v�> T� Nitrification line: �
U. � f�� �
Other disposal far.ility: _ ,
Water supply and sewage disposal facilities location,_ installation and �
protection must meet state and local regulations. • � I
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 haza�d. I
Septic tank and nitrification lirie bIUST BE .INSPECTED AND. A.P- i
PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INST ON IS COV- �
ERED AND PUT INTO USE. • i
� ' ��
Date approved• Sigried ;
Well• ( ' Saiiitari .. • �
v ;
Sewage Disposal• Counter- - .. '
- � aigned . '
B3'' (Owner or his rep.r.esentative) ;
. . • ;
Certificate of Complelion t . '
C% �.
Date A �—��. _ `%:
PP�ved: _ � By: ' �
anitarian . .. ,°. '�4
� (OVER) �p'��`�
Location of well and sewage dispusal facilities sketched on back.
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