P63066 Hwy 801SLOCATION ' t�.� �OWN ER�' '! f,
FNA CASE NUMBER
Dimensions VA CASE NUMBER
Volume
Type secondary
treatment
nitrification line filter trench
No. of bedrooms
Permit Number Date
Approved Date
Approved by A— - -
v
Contractor or Plumber
Address
Remarks
SEWAGE DISPOSAL RECORD