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The Distric� Health Depar�ment
CASWELL - CH4THAM ,- LEE - PERSON COUNTIES
Water Supply and Sewage Disposal
• - IMPROVEMENTS PERMIT No.�-�-
I'/�ate j� � i� d�
Owner: � � ✓��-�` � � V�� �� a'+
Location:
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Contractor:
Water Supply: Private Public
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Sewaqe Disposal Faciliiies: No. bedrooms
washing machin /��e�sut�atic appliances
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Size of tank: � �� �� NitriBcation
Other disposal facility:
_ Dishwasher, Dispo�al�
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line:
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-
PROVEB BY A MEMBER OF THE DISTRICT HEALTH DEPAR.TMENT
STAFF BEFORE ANY PORTION OF THE IN L TI N S COV-
ERED ANB PUT INTO USE.
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Date approved: ��^^^��
Well: � Z� � � � �,�,.�„" �
Sewage Disposal:
By:
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(Owner or his representative)
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Certiticate of Compleiion i
Date Approved: 3� �' 3 By; '
Sanitarian
(OVER)
Location of well and sewage disposal facilities sketched on back.
NOTE: e sketch of installation showing lot siz� shape, location of house, septic tanks, ies, 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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