P4667 Dulin RdLOCATION OWNER
PRIVY: SEPTIC TANK: FHA CASE NUMBER
Type Material
wood concrete
Number Dimensions VA CASE NUMBER
New Volume
date
Repaired
WATER SUPPLY:
Source Id,
If well, type
(Bored)
(Drilled)
(Dug)
Distance from nearest
pollution s�� ft.
Form No. 473 (Rev. 9/58)
Type secondary
date treatment
fii O
nitrioClation line
No. of bedrooms i3
Permit Number
Approved
Approved by
Contractor or Plumber
Address
Remarks
SEWAGE DISPOSAL RECORD
filter trench
Date 274-6 -6
Date