P33066 Eaton Church RdLOCATION 84(��/ori ��h, .�d. OWNER `— CL r,
PRIVY: SEPTIC TANK: c �J FHA CASE NUMBER
Type Material LaC�
wood concrete
Number i Dimensions VA CASE NUMBER
New
Repaired
WATER SUPPLY:
Vol ume
date
Type secondary
date treatment
nitrification line
c
Source ,Qi — v� c h�
If well, typeGf.�(Do)/tl
G/
(Bored)
(Drilled)
(Dug) �;II
Distance from nearest
pollution ft.
No. of bedrooms .>
filter trench
Permit Number Date
Approved Date
Approved by - i )-
Contractor or Plumber
Address
Remarks
SEWAGE DISPOSAL RECORD
Form No. 473 (Rev. 9/58)