P72275 Bodford, FrankSEWAGE DISPOSAL RECORD
__________________________________County Health Department
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -
Name of Occupant -------------------------------------------- W -------- C-------- Location of
Name of OwnerF-m-h- e&d,,(i�--n�_____C________ Date of Installation______ _________.__
Type of Privy Constructed ---------------------------------- Number .__..______________-_--________ New or Repairedll.ce?cs%
Septic Tank --------------------------------------
Date Inspected ------------------------------------------ Permit No.---------------------------------------
(concrete, metal, etc.) Capacity .---------------------------------------- --- F.H.A. Case Yes --- ----------------------------------
ri �+ o -----'------------� -----------------
Number of Users -------------------------------------------- Type Secondary Treatment _s_7�____T_ ___Z�1J_Z,_r_Ne,.__--______
Sourceof Water Supply------ L° �--------------------------------------------------------------------------------------------- ----- ---- ---- ------------ ----
Contractor or Plumber - t7! �a ! _ Address - c �1------ —
Approved by :
Remarks
(Over)
N. C. STATE BOARD OF HEALTH FORM NO. 207
NOTE :Make sketch of installation showing location of house, septic tanks, privies, water supplies on adja-
cent property, etc. Write in measurements in order that installations may be located at later date.
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