A40 119The District Health Deparfinent
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply, �and Sewage .Disposal
IMPROVEME�'cT$ pER1�IT No—�y-�-�
. ... . �' T..a.. �n�Z.�'..-7S d —
Owner:
Loc ,�tio
IContractor:
Wate! ,Syp�
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sal Facilities: No. bedrooms '`— Dishwasher, Disposa�,
iine, other automatic appliances
— � , �(,� Nitrification line: - , �1f�
Other disposal facility:
Water supply and sewage d.isposal facilities location, installatiar. ,and
protection must meet state and local regulations.
Septic tank should be pumped out every 3 to 5 years an3 shall be main-
tained by owner in such a manner as not to create a public health hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVEB BY A, MEMBER, OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTIOIV OF THE INSTALLATION IS COV-
� ED AND PUT INTO USF�. ���,� �
Date approved: '
r �
Well: � �
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Counter-
aigned
(Owner or his representative)
CertiScale of Completion �
Date Approved: ^ y; �
S n arian
(O
Location oi well and sewa�e aispog�l ta�iliti�s sketehed on b�ek. ��
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The .District Heolth Department�
CASWELL - CHATHAM - LEE - PERSON COUNTIES
+. -
;--� ; '� Water Supply and .Sewage Disposal
•_ ;•'�'i`".�,,.�%�` •'-`, IMPROVEMENTS PERMLT No.
�`ate �+�— -�.�
�F , � Owner: ��' � � �lJ��"'�'T�i�
_.---'. �
-- pq Location: •
I . �: i ` ' • � . �'t' .S
.. ,1�..�'►r, f�.�r'�,-.
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,.,_ - ' p, Contractor: �- •
�`N �Jti � Water Supplp: Private � � Public
`"�� U ?`' < <"��:� i: I �
:, .
,
Sewage Disposal Facilities: No. bedrooms "� Dishwasher, Disposal.
washing machine, other sutomatic appliances
l .
Size of tank: � � �-' � �� �� • %� � Nitriflcation line: �� t- r�; ` �' '�� : �
:��
,� ,
Other disposal facility:
Water supply and sewage disposal facilities location, installation and
protection must meet state and local regulations.
Septic tank should be pumped out every 3 to 5 years an3 shall be main-
tained by owner in such a manner as not to create a public health hazard.
ROVEB BY A MEMBER OF THE DISTRICT HEALTH D PARTMENT
STAFF BEFORE ANY PORTION OF THE INST.ALLATION IS COV-
ERED AND PUT INTO USE. �'' n
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Date approved: Signe�-` � � � � .
Sanitarian
Well:
t.•� . > -!._
Sewage Disposal: Counter- j j��, ,; '�
aigned �• ` ` c �.: �'r ;- �.}'.,'7
By� (Owner or his representative) ~
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Certiticate of Comp eti .. -�
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Date Approved: y• �`
anitarian
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Location of well and sewage disposal facilities sketched on back.
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