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The District Health Department
CASWELL - CHATHAM - LEE - PERSOy COUNTIES
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Water Supply and�Sewa�e Disposal
IMPROVEMENTS PERMIT �No.
Owner: _
Location:
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Contractor: �1 �`��- �''`x'��
Water Supplp: Pri�atej� Put�lic �
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Sewage Dis sal Facilities: No. bedrooms �� ishwasher, Disposal,
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washing machine, other automatic appliances
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Size qf tank: l t �!�`�'� --Nitrification line:
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Other dispqsal faFility: f�, '' j ��r � � ' , f ' � �
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Water supply and sewage dispb"sal 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-
PROVEII BY A MEMBER OF. THE DISTRICT LTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE,.i ST ATION IS COV-
ERED AND PUT INTO USE. �
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Date approved: Signe �
- Sanitari
Well:
Sewage Disposal: I Counter-
BY: signed
(Owner or his representative)
Certiticate of'Compleiion -
Date Approved: �� � � ��. By: ` -
a itarian
(OVER)
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 on lot. Write in measurements in order that installations may be located
at later date. Note location of water supplies on adjacent lots.
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