A23 88ihe District Health Depart�ent
"`�' CASWELL - CHATHAM - LEE - PERSON COUN7IES
... .
`� Water Supply and Sewage Disposc�l
IMPROVEMENTS PERM3�', l,�o�—
Owner: �-�
Location:
IContractor: �
Water Supplp: Private
vi�;r e
Public
Sewage Disposal Facilities: No. bedrooms Dishwasher, Disposal,
washing machin other autom tic appliances � ,�
Size o! tank: ' Nitriflcation line: ����1 3
��)�t � '
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 I STALLATION IS COV-
EftED AND PUT INTO U5E.
Date approved: Signe
�
Sanita ian
Well:
Sewage Disposai: Counter-
BY• aigned
(Owner or his representative)
Certiiicafe of Complelion " "
Date Approved: � ��l� By: 'a''
Sa r ar�a
(OVEft)
Location oi well and sewage disposal facilities sketched on bacic.