A23 83The District Health Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Sewage Disposal
IMPROVEMENTS PERMIT No.�----
Date 7 �'��i'� —
Owner: ��_�L�`�� � � �
Location:
[
`� Qt�� ` � Q:---
„-�'..F S P �' l� �
� �Contractor: �
Wale: Supplp: Private � � Public
Sewage Disposal Facililies: No. bedrooms
washing machin other sutom tic appliances
Size of tank: Nitriflcation
Other disposal facility:
Dishwasher, Disposal,
Water supply and sewage dispos�al facil�tfes 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-
PROVEII BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE IN TION COV-
ERED AND PUT INTO USE.
Date approved: Sig e
Sanita i
Well:
Sewage Disposal:
By:
�
Counter-
aigned
(Own or his re resentative)
Cerlificale of Complelion
Date Approved: � ( � BY�
Sa itarian
(OVEA)
Location of well and sewage disposal facilities sketched on back.