A24 116�� u ,�1 reU�.�� �-'��� ��'
The D�stric't.�leaith De artment
, p
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Sewage Disposol
IMPROVEMENTS PERMIT No.
Date _ _
Owner: �
Location: • (
1 r, . ,�, , •, „ � ' '�.�,1�_
iv t, ;. j� y-•_�`;:�;? f.>;-� c� ;%r ti ��,
f � �r,r - � �
-�i�t : i C-� ��'f i Ll' �, c, I � 1 i� �{i�... i
Contractor: � � ���;
Water Supply: Private � � Public
�Y\ !
; i ,
i
���: ( Y
C�
Sewage Disposal Facilitiesc No`. be�rooms --? Dishw �her,rDis qsal, �
washing machine, other a tomatic appliances b �
Size of tank: << ��'-� NitriBcation line: ' v��
�. : � 1�;.�cvr•�--- , - �
Other isposal facility:
, � `
Water supply and sewage disposal facilities location, installation an
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 HEA�TH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE.
Date approved:
Well:
Sewage Disposal:
By:
Certii'icaie of Completion � ��
Date Approved: ��l ,��� BY: '� ���
ni arian
(OVER)
Location of well and sewage disposal facilities sketched on back.