A23 73eri
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.: �The �District Hec�f.h Department
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Oraage. Person, Caswell, Cha3ham, Lee Counties
Wate�r� Supply and Sewage Disps�sal
IMFROVEMENTS PE IT� �To.�{y' ��
_n�t� �'r�- � �-�
Owners � ��.���
Location• ..C? �'-- �1.- '� � �*� t �,'S �_� ..
, ::�;,��t<. ':. ^:•;.� J5^ i'l�r; I �r�� .
p, , Contractor:
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� ` Wa}3es Supplp: Private.,,�
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I�.�S�i2lry . :
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S�ewage Disposal Facilitiea: No. bedrooms � Dishwasher, Disposal, ,
washin achine, other':•suto ' �pliances � +
Size �k• –� � r,� i n e: ��� `' �-�..$ • ;
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Other� �d7isposal faci ty: .
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, S ��.. :. �� St"."�'7 • J".. .�%�,
Wa�ler supply and sewage sposal facilities location, installation and
pro",ection must meet state and local regulations.
Septic tank should be pumped out every 3 to 5 years and shall be main-
tau�ed by owner in such a manner as not to create a public health hazard.
Septic tank and nitrification line MUST BE INSP'ECTF,� AND AP-
PitOVF.D BY A MEMBER, OE THE DISTR,ICT HEALTFi DEPARTME�NT
S'PAFF BEFORE ANY PORTION OF THE INSTALLAZ'ZON �I5 COV-
ER]GU AND PUT INTO USE. - - -
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Date approved- � ,Sign `� ,: y,�_ f� �, -_
, ' '- � I .581]� . ��. . � .
We.11:
,Sesuage._Disposal•; _ • Counter= '
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• BY� '-'(Owner�or�his� presentati ')
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� Cea 'tai'icaie o� Comp tio
• _ � .
Date Approved: By ' � � - `
, - _ Sa ; tarian
-' {OVER) .: . .. . .
, Location of well� and sewage� disposal ��acilities sketched• on• back.
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