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�he District Health Department
CASWLLL,- CH�1TH�1lu1 - LEE - PERSON COUNTIES
Water Supply and„Sewage Di�s�o$s�l
IMPROVEMENTS PERMIT No. � �
� 1 Date ' ' -
Owner• � �'tT,—r "zT ���` �t `�- L-_C { `�-� "` �i''
Location: �- `�d P �s�
washing machine, other sutomatic appliances �� ,�,/
Size of tank: 1.!?� yi' ;�.!'! Nitriflcation 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-
PROVED BY A MEMBER OF THE DISTRICT HEA� TH DEPARTMENT
STAFF BEFOftE ANY PORTION OF,THE INSTALLATION IS COV-
ERED AND PUT INTO USE. r-,��``
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1' / � � �
Date approved: Signed ?�-�` � � P
Sanitarian
Well:
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Sewage Disposal: Counter- • ���;'��
9igne f
BY� (Owner or his representative)�
Certiiicale of Completion
s��-��-/ r
Date Approved: � By:
itarian
<OVER)
Location of well and sewage disposal facilities sketched on back.
N TE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water
upplies, etc. Note special problems existing on lot. Write in measurements in order that installations may be located
- t later date. Note locatio of water supplies n adjacent lots
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