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Y <br /> tG� <br /> 53 <br /> ORANGE COUNTY HEALTH DEPARTMENT Improvements Permit Date: g a Township: 1:A16 <br /> Owner: 111 L, j 2 Tax Map Na: <br /> IT <br /> Location:T)N ' P, 1) Block: Lot No: IA <br /> Contractor: Water. Su 1 Private Public Community <br /> Sewage disposal facilities: No. Bedrooms: Clothes Washer Garba e-D �posal • Dishwasher <br /> An <br /> Size tank: DCO --At r `Ttljo <br /> �-vl�� Nitrification line with undisturbed earth clam each 50 feet <br /> Other disposal facility: 'r I �. � <br /> Water supply and sewage disposal facilities location, installation and protection must meet state and local <br /> regulations. Septic tank should be pumped out every 3 to 5 years and shall be maintained by owner in such a manner <br /> as not to create a public health hazard. Septic tank and nitrification line MUST BE INSPECTED AND APPROVED BY A <br /> MEMBER g JE O. GE COUNTY HEALTH DEPARTMENT STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COVERED AND PUT INTO USE. <br /> THIS PER IT IS Y fVALID FOR STRUCTURE LISTED- FOR -3•YEARS FOLLOWING DATE OF I SUANCE. <br /> Signed.: <br /> Countersigned: ] 1 / <br /> ' Sanitarian n � ) . w r epresentative <br /> Certificate of Completion) Date approved: "[ {� By: <br /> MOM <br /> Sani arian <br /> Remarks: <br /> GRID SPACE: <br /> t <br />