107 E Robin Drive Lot 14Z.
LOCATION l Da4zL !R OWNER O
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material
wood concrete
Number Dimensions- VA CASE NUMBER
New Volume 9 a
date -�
Repaired Type secondary
date treatment
nitrification line filter trench
WATER SUPPLY:
Source
If well, type
(Bo red)
(Drilled)
(Dug)
Distance from nearest
pollution ft.
Form No. 473 (Rev. 9/58)
No. of bedrooms
Permit Number Date
Approved _ Date1¢-
Approved by r .[Ls• "'—
.
Contractor or Plumber_
Address
Remarks
SEWAGE DISPOSAL RECORD
INUM ii
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