HomeMy WebLinkAboutSOUTHWOOD PARK BLK 2 LT 220
Z
Rev, July )958
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
Form ~pptoved
Budgml Bureau No, 63~R296.G
PART L--TO BE COMPLETED BY FHA
INSURING OFFICE
MORTGAGOR OR SPONSOR
;UBDIVISION NAME
MORTGAGEE
SERIAL NO.
BL~CK NO.r~ LOT
TOTAL NUMBER~
[] Public system
SEWAGE DISPOSAL
[] Public system
~-1 Yes [--]No ~W~3.~g []Yes F~'INo
[] Community system [] Iu ividual [] []
PART IL--TO BE COMPLETED BY. HEALTH DEPARTMENT
tEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [] State [] County [] Local Department of Health that this individual water-supply system
[] is [] is not satisfactory as a domestic water supply for the subject property.
It is the opinion of the [] State [] County ~ Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
[] Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
--~;ATE S,GNATURE ,_~,,, /3' / . / / J UT~E
Aug, l~ x~u I ~ / --
heal~ authority,
PART IlL--FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
Z have ~icw~ ~he ~o~e~oJn~ and ~he
individual wa[e~-supp]~ system ~ considered
DATE
SIGNATURE
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
] CHIEF ARCHITECT
]DEPUTY FOR CHIEF ARCHIT~:CT
FHA Form 257~
Rev. July 1958