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GASWELL - CNATHAM - LFE - PERSO�d GUUNTIES
����� ������y ��� ������ �°s������
%I�LPROi/EIr/[�:fl�Y'd'� P�.F�.Z'di`L" No.
•'�"1 ABte ' j -^ �; , . �t
........ f .
OSNIIQI: � r.,� r 7 V�� i�i.
��� �-V-�l �°�
Lncation:
� t t t, . f- ^ ! ��—
. 1 � � • ,
Contractor: 1 �'�" 1 S -
�'VaBa:s �s���l�as �rivate —�..•-^='"" EDubli� --
5��,��� i�is�cusal ��ci9iai�s: No. bQdrooms =-
washing machine, other sutomatic appliances ___
Size o� tank: � ��� �' `^'� , Nitrifacation .lin�
,
Other disposal facili4y:
��shi.v�sla�Y�, �is�osal,
V�later supply and s�wage disposal facilities loca�ian, inste�llatzon and
protection must mQet state and local regula4ions.
Septic tanlc should be pumped out every 3 to 5 years an3 shall be cnain-
tained by owner in such a manner as not to create a public healtn hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AF-
PROVEB BY A MEMBER OF THE DISTRICT HEALTH DEPAR,TMENT
STAFF BEFOR� ANY PORTIOIV OF THE II�ISTALLATION IS CO�/-
ERED AND PUT INTO USE. �
%"' � '� J` ri f 1
; � �� , �; �����
Si nedl r���,l �`i; t,�'E � ;� :`���..;�.�ti
Date approved: g ; �Sani�tar4an�
Well:
Sewage Disposal:
By:
. ,i / ;
Counter- � (' f;/, � �_ta.c-•t..�•�. �,
9igned _ ���-'
(Owne�'or his representative) -
1 ''
�
Certiiicate of Completion � �`� ,/�: �
� i ; �� �'�
Date Approved: ��z �� BY�� �
Samtarian
(OVER)
Location of well and sewage disposal facilities sketched on back.