A40 32A, ' ' ' r � w�-�- _.__-.--- - -
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.;��= . Thek District �i�ealth Departmenf � ��
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Orange, Person, CaswelL Chatham. Lee Couaties �
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:SEPTIC TANK PERMIT
I Dat � — �.•
Nazne of owner• � L1 t'�l.�S �?`I'I'±DC, W_�
Name of contractor: �me'-�.-P11Z�J� ��� �� o�'�'1
�:f�� 3 ���C o rc� . i�IC,
Address and Directions P
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Person or firm doing installation:
Address
No. of persons�to be serve� Bedrooms 1, 2,�.
v,:.:
Additional appliances to be used: Disposal; dishwasher, washinB
machine � ' � 1'1 � � �
Recommended• Septic ta �� � o a� 1
Nitrification Iine: � ' X -!
Above recommendation based on information received and observed
soil conditioa Septic tank and nitrification line must be inspected and
approved: by a member of the Dist:ict Health- Depaztment. staff...before
any portion of the installation is covered.
Signe�
Sanitariaa
O.. David Garvin, 1VI.II., M.P.H.
District Health Officer
Countersigned
(Over) �
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