A24 70� --1 r-, ._ . �-, . . _ ,: _
_ . __ . _.,....... _. _. _ _. __._.._.. __ ...._____._- -. __:______,_.___._�_._...__._. . 9
The Distriet Health Depc�rtr�ent�
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Sewage Dispos�l
. IMPRQVEMENTS PERMIT �i"`�'� �
Date ' _-c_, ,( "'.
'�r�'----; �.- - l
'`Owner:
Location:
. � r�..L�. �i
. �,,.. �l •- y "` ,.
, _.�.. _
. _ � _`✓ �� � ,
Contractor: _�'
Water Supplys Private ��--�rbiic
Sewage Disposal Facililiess No. bedrooms �� Ishwasher, Disposa�,
washing machine, other sutomatic appliances i
Size o! tank: — � ,L f � ,! � ! o ��� r NitriBcatIon line: �, � ���1 '� � �;
�•�
Other iilsposal facility: ✓ � ` � �, , .�. ) .i !� r. v, . , , ��
� ' ��• � � y � �
, :� � / �I �y`
. Water supply and sewage disposal facilities locaFBo'Pt, in alla�t�on a�d
.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.
Septia tank and nitrification line MUST BE INSPECTED AND AP-
PROVEII BY A MEMBEft OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF �THE INS L�TIO I COV-
ERED AND PUT INTO USE. /� /�/�,
i' �!. ,l , (J�' � i
� , ,� /� 1,J�,, f � '� ' f�`` . �,
Date approved: Signe � I �� �r �f �� "�'% '� j �'
Well: " ! %� .. `S ni rian , �
+,, �.
Sewage Disposal• y— 1Sr" F�7
By: �',i.Gl.�.�-•,:.� G� . /N.�...(YF/7�.._ �
.. . , ��� .. . . . . .�
Counter- rIJ �,,,4?�,,,�), (�j�a,,��;,�,
aigned �
(Owner or'hts representative)
\
.Certiiicate of Complefion /� 1, �
, , ,
_.. � ( , �J <
� Date Approved: By: � �, � , f �'�- -•� ( �„ � c .;�.�-
Sanit rian I �
� (OVER)
Location oi well and sewage disposal facillties sketched on back.