A31 102The District Health Depar�ment
CASWELL - CHATHAM - LEE - PERSON COUNTIES
k �
Wa�er Supply and Sewage Disposal
IMPROVEMENTS PERMIT No.
ate =� .� 3 -�
Owner: f' 1%1v'► • ��nJ/ e.
Location• � '
i
_ �C
Contractor: ,
Water Supplp: Private —�� Public
Sewage Disposal Faciliiies: No. bedrooms � Dishwasher, Disposal�
washing machine, other sutomatic appliances
Size o! tank: ' Nitriflcation line:
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.IN,SP LATION COV-
ERED AND PUT INTO USE. l
Date approved: Sig
Sanitari
Well:
Sewage Disposal: Counte /�
aigne
BY� (Owner or his representative)
Cerlif'icale of Comp etion
Date Approved: • '� B :
S ian
(OVER)
Location of well and sewage disposal facilities sketched on bacic.