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A26 66.. . _...: . �.4- a. r '�■■��./ ' • ��..■� � . �� 1��. - �� , �11 ��►'�� " : �'��'�■■ �, . . ►11i�i��■ `-�_..■ � �1��■ ►��l„■■■■ � �'��!,11��■ � �►�t�;�l�� 1�� , ��■■■ . ��■■■ ��■■ ■ -_ ��s � �■■ ��■■� �'.�� .I�I.■.� I�� I�� i�1��■�� ir�� I��■■■■ I��■■■■ � _._ . _ _. _ — �,;;.�.,.�:.;:� �c?":P�w�i'r`�'� � _ �� n�-v�5��-»�.. a�.�.�..� —�—r-- --- •- ...: :. � � .. .,. - � Ch am Lee Counfies . prange Pers Caswell:. �- _ � - �`'' �Z , . .x. ...+: . .. . - -� �°tl.r �'-�' 1/!Vl � ' 1 : '� . water Sup.p��ared. SewQ�e ;, isposa �. . � . . IMFRQVEMENTS PER T 1�0. � /. . � • , Dat '' � � Owner: ... ... . - , _ o � , � � � Gq Location: ,t' t" � • �� . . �_ 1 � - i .�I�� 1' . . ., • �' ; � . � ,. j . • � Contractor: � f -` � , • • � V'laier Supgly: Private _ k ;,, ^� % public� _:, . I�Io. bedrooms � liances '� - � ashing rmachine, o er. ,au}om ic app.' e of tan . Nitrification line , . ;� I Other disposal facility: , .. �' ; �Water supply :and sewage .�sPasal fa�� °`tsp instal� �� protection must meet state �and loca regulations.. � Septic tank �hould be pumped out every 3 to 5'years and shall tained by owner in such a manner as not to create a public heal� Septic tank and nitrification line MUST•• BE INSPECTEI3 � PROVEl? BY A NLEMBER;';�C1F THE DISTRICT HEAI.TH DEPA STAFF BEFORE ANY PORTION OF THE IN5TALLATION �RED ANI3 PUT INTO USE ,. �,� f. 4--1� �f; ,. �i� � �� , �� ;�. � Sl�e� � ,i v - - , Date aPproved• ,,� Sanitarian `' Well: t ... � . �- Sewage Disposal• Counter � � ; ,fiS . . �� . ... . 91�I10d r . . - •" . . �. BY: (Owner or his repri �. ' . . . r,...�e! , ' �' �� F✓� iY��.:` � Certificate of ComPleiion i � t i ;:� � � < ,� � ':.l '��•.�%' Date Approved: .—.--'�----- BY Sanitarian • (OVEft) Location of well and sewage disposal facilities sketched on back. '�: . ' . -- _ . _ _ _