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The District Heolth Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Sewage Disposal
IMPROVEMENTS PERMIT No.
Date � r L � ` %
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Owner: � ^ �
Location: �,�
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Contractor: .�.14
Water Supplp: Private � Public
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�"l.�Y
Sewage Disposal Facilities: No. bedrooms Dishwasher, �
washing machine, other suto atic appliances —
Size of tank: ��'' '�'`-� �� NitriBcation line:
; - n,��f?.,�_
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 MEMBEft OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION O
ERED AND PUT INTO USE.
Date approved:
Well:
Sewage Disposal:
By:
Certiiicate of Completio
Date Approved: � '�
J(Owner or his representative)
/
By
anitarian
(OVER)
Location oi well and sewage disposal facilities sketched on back.