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The District Health Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES
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Water Supply and Sewage Disposal
IMPROVEMENTS PERMIT No.
! {1' �� l Date �� � Z � .1.�
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Owner: � � �'��✓�
Location: _
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Contractor: „� ��2.�--�-�
Water Supplp: Private • � Public
t��C► 54,.,,
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Sewage Disposal Facililies: No. bedrooms Dishwasher, Disposal,
washing machi , other automatic appliances
Size of tank: _n����� Nitrification line: .�'
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.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVEB BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED ANB PUT INTO USE. �
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Date approved: _ Signe �
Sanitarian
Well:
Sewage Disposal: I Counter-
signed
BY= (Owner or his representative)
Certificate of Completion
Date Approved: '� �-� � gy; _�r'�,r:��l;�-�!� 1�l�-�-t�� �
Sanitarian
(OVER)
Location of well and sewage disposal facilities sketched on back.
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NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water
supplies, etc. Note special problems existing on lot. Wrste in measurements in order that installations may be located
at later date. Note location of water supplies on adjacent lots.
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