A32 11A/
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The District I��alth Depertrner�#
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Sewage Disposal
IM�PAOVE'MENTS PERMIT No.
Date
Owner: �! j�� � G�//�
Location: ��^.�/
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Contractor:
Watez Supplp: Private Public
Sewage Disposal Facilities: No. bedrooms Dishwasher, Disposal,
washing machine, other sutomatic appliances
Size of tank: ���� Nitriflcation line: C� X 3�
� ��
Other disposal facility: ��� � �� �rJ(G ,� � fi � '
%Iv �% �h� c� h � e -� �Pe rn�,�
Water supply and sewage dispbsai faci iti 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-
PROVEI3 BY A MEMBER OF THE DISTRICT HEALTH DEPAFtTMENT
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE.
Date approved: � Signe t���
Well: �_ Sanitarian �
J
S age is osal: G%��''`- Counter-
�� —�� 9 aigne O ner or his re res�
i P )
Cerlificate of Complelion
Date Approved: � By:�� �
Sanitariar� ?�����
(OVER)
Location of well and sewage disposal facilities sketched on back.