A30 38��� '
The� Distric� Health: Depar#menf
_ v: . .
Oraage, Person, CasavelL Chatham, Lee Counties
SEPTIC TANK �P�RMIT
. . . Date � "" ��� ; � �
•Name of owner: ,r.,l1`2�r,['-� �1S�Y �lZC�I'1
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� Name of. contractor: � � f'�'1 ►11Q-�' ��'��,�,
Address and Directions }�f '�- Q- n�[��1"t� .h ��, r
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Persoa or firm doin J�.
g installation:
Address :
No. of persons to be�serv��'"' "" ""''� t'��-`�: -� Bedrooms 1, 2,Q4. �
Additional .appliances _to be used:, . Disposal, , dishwasher� washing �•
machine �,�;:� j'j �•
Recommended� . 5eptic tank I��(I� �
Nitrification line: - �� � � ��
' Above recomme.ndation- based on information received a.nd observed
soil coadition. Septic tank and nitrification line must be inspected aad
approved by ainember�of the Disirict Health Depazt=nea! staff before
any Portion, of�the installation is covered.
Date
. '.
Countersigned
- (Over)
.Sfgrie�
�S3I11�T18II
O. David Garvin, M.D.� M.P.H.
District Health Officer
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