P1966 Milling RdLOCATION I (,/�k °�hj QEs�a�� OWNER /7 / Q%� �o S /e r
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material �ein�brc�dLDn�r'N%e
wood concrete
Number
New
date
Repaired
date
WATER SUPPLY:
Source ,< <
If well, type
(Bored)
(Drilled)
(Dug)
Distance from nearest
pollution ft.
Form No. 473 (Rev. 9/58)
Dimensions
Vol ume
VA CASE NUMBER
Type secondary
treatment G oo 1f 2
nitrification line filter trench
No. of bedrooms e��i,t Darn
Permit Number Date
Approved Date
Approved by ka �* �
Contractor or Plumber 77-1 QoLdo '7' (far
Address 6 C- ks U Cr e
Remarks
SEWAGE DISPOSAL RECORD