A27 118a
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The District Health Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES ..
Water� Supply ond Sewage D'isposal
IMPROVEMENTS PERMIT No.
• • Date t� - �
Owner: Q- � S' '�
Location: � ' � �
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Contractor:
Water Supplp: Priva�e �Public
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Sewage Disposal Facilities: No. bedrooms -A'- Dishwasher, Disposal,
washing machin other automatic appliances
Size of tank: � � +� Nitrification >inP� ! :
C) � �n�Yi�/ ...
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-
PROVEI} BY A MEMBER OF THE DISTRIC�HEALTH DEPARI`NIENT
STAFF BEFORE ANY PORTION OF THE'INSTALLATION IS COV-�
ERED AND PUT INTO USE. J / �. ,
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Date approved: Signed " ' ' � '
Sanitarian'
Well:
Sewage Disposal:
By:
Counter-
signed
(Owner or his representative)
Certificate of Compleiion y��
Date Approved: � By:
Sanitarian
(OVEft)
Location of well and sewage disposal facilities sketched on back.
NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water
supplies, etc. Note special problems existing Qn lot. Write in measurements in order that installations may be located
at later date. Note location of water supplies on adjacent lots.
(1)
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(2)