A23 31�
V
f
°�'�e ��s����� �9����� ������a����
CXSWELL - CHATtiAM - LEE - PERSON COUNTIES
�a�e� Supp�� �ra� �e��ge �i��os�9
IY�IPROITEMEPITS �ERMIT No
-�...��� .��,��,���fi�� �to . �
_. ;��-�' - <i
�WII2i: �_ . -
1.O,C8t10II: �
, -.
. . �'��T� -
, ., .
� �
� p, Contractor: T � �-- �=; �+ 'w= -" --
m
� •� Watez Supplp: Private • �- �"`'`�� Public
Sawage Dispasal Facfliiies: No. bedr`ooms '� Dishwasher, Disposal,
washing machine, other sutom tic appliances f
Size oi tank: �� NitriScation �-�° � ,
lina-
T-
�t�1CGT dlSpOSHl f8C111�:
��/J ��?.:/
Water supply and sewage disposal lacilities location, mstallation �nd
protection must meet state and local regulations.
Septic tank should be pumpe3 out every 3 to 5 years an3 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 INSPECTFIl AND AP-
PROVED BY A NiEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTIOlY OF THE INSTA�7�ATION IS C�V-
ERED AND PUT INTO USE.
�,. ,�f j�,j 'M�'�'''_
; � . � i�/ '�iijl d
;%'�; ,�.�'
Date apProved' g�d' : � :'. � •',%t 1,. -_ i :.l.�
:.S6nifarian
Well. `—�
- -�
Sewage Disposal• �� �i�j_���
edj ` �
By (Owner or his representative) '
CertiSeate o� �Completioa �`�
Date Approved: S�� �� BY' r
Sanitarian
. (OVER)
Location of well and sewage disposal facilities sketched on back.
i I/Z I/OS' —.l�,�,►u, E,.�/ �c,,{��" �Y�-r-r- O ��c 5� � i 5►
t ! '�"
��E:� � cb•¢►� �'� Cs1�i� j '3� �1 �F'-''r''��.�'� l,�'�' =+�6 �+C. .
�
� � 2 � -�"�
�a� � Sa�
- ��� -��-s-x�
��.�- � s , s,.