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The District Health Deportment
CASWELL - CHATHAM - LEE - PERSON COUNTIES
1Nater Supply and Sewage Disposal
IMPROVEMENTS PERMIT � .\ s�—
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Owner: �.�Y 1<'f �{�, ��� <������ � � �' �7r1�=�
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Location:
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Contractor: �j� �
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Water Supplp: ivate • Pub'lic
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Sewage Disposal Facilities: No.
washing machine, other auton
Size of tank: ,� %�l� �� � �''���
Other disposal facility:
Dishwasher, Disposal,
: appliances c� / �,�.�,,
Nitrification line: � �*'-�-�' �L�
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 an� 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 DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INS'IjALLATION IS COV-
ERED AND PUT INTO USE. /
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Date approved: — Signed;! i � !�=�r "1'�st ��
Sanitarian
Well: ' �
Sewage Disposal:
By
Counter-
signed
(Owner or his representative)
Cerlificaie of Compietion M�'�'L— .^
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Date Approved: �� By� "" � _..
Sarii arian
(OVER)
Location of well and sewage disposal facilities sketched on back.
NO : Ma sketch of installation showing lot size and shape cation of house, septic tanks, privies, water
suppl , etc. Note special problems existing on lot. Write in m su ents in order that installations may be located
at t date. Note location of water supplies on adjacent 1 .�
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