A23 36q-'1, 57�1 �
The District Health Department
CASWELL - CHATHAM,- LEE - PERSON COUNTIES
Water Supply and Sewage Disposol
IMPROVEMENTS PERMITr,�To. �
Dat
Owner: � n� 1� � E' S V 1 c� ��P i.J S
Location:
7� /� f! ' .
(`nntrartnr• � Q � S y
Water Supplp: Private � Public
�
Sewage Disposal Facilities: No. bedrooms Dishwasher, Disposal,
washing machine, other auto atic appliances
Size of 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 INSTALLATION COV-
ERED ANB PUT INTO USE.
Date approved: Signe
Sanitazian
Well:
i
Sewage Disposal: Counter �
BY: aigne
(Owner or his representative)
Certificate of Completion / .
Date Approved: � By•
S��an
(OVEA)
Location oi well and sewage disposal facilities sketched on back.