A29 52The Districf ��ea�h Departmenf
Oraage, Person, CaswelL Chatham, Lee Couaties
SEPTIC TANK PERMIT
RoNA i'i AZELDa+e �—' y�' �— j0 �
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Name of owner: ,
Name of contractor:
Address and Directions ' �
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i ��,e c i/,' 1 I�
Person or firm doing installation:
Address
No. of persons to be serve� Bedrooms 1, 2, 3, 4.
Additional appliances to be used: Disposal, dishwasher, washing
machine � n � �
Recoxnmended: Septic ta / �
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Nitrification line:
Above recommendation based on information received and observed
soil condition. Septic tank and nitrification line mus! be inspected and
approved by a member of the District Healih Depaztment staff before
any portion of the installation is covered.
Date Approved: �— 'y�--��
By
Signed
Sanitarian
O. David Garvin, M.D.� M.P.H.
District Health Officer
Countersigned
(Over)
; NOTE: Make sketch of installation showing location of house, septic tanks, privies, water supplies on
� adjacent property, etc. Write in measurements in order that installations may be located at later
date.
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SUGGESTED INSTALLATION (Date ) FINAL INSTAIsLATION (Date )
(Road or Street) (Road or street)
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