A35 96h
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The District Health Department
CASWELL - CHATHAM - LEE -.PERSON COUNTIES
Water Supply and Sewage Disposal
IMPROVEMENTS PERMIT No.
�--��''' Date �- �r - �>�'`
Owner: + r� :,� y (� fi �`-� �r, u� p s —
I,ocation:
5, f�r,; __ 1 ��
¢`
Contractor: ' 2�l�'�
Water Supplp: Private �,--� Public
�;,..-
Sewage Disposal Facililies: No.'bedrooms Dishwasher, Disposal,
w shing machin other auto{natic appliances
Size of tank: �'%�� L�'� ��x � Nitrification line: ���' �/ x-f~
U - .
Other disposal facility:.
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 iri such a manner as not to ereate a public health hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF :THE INSTALLATION IS COV-
ERED AND PUT INTO USE.
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J '4� �f'n I�YY�fJ, ^ _
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Date approved: — Signed ��
, . Sanitarian .
Well: ,
Sewage Disposal:
By:
Ceriificate of Completion
Date Approved: ..G� `� By:
Counter-
signed
(Owner or his representative)
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(OVEft)
Location of well and sewage disposal facilities
on back. ,
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