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A23 40� � : � . . .' 'a ' .. Size The District Health Department� Orange. Peraon. Caawell, Chatham, Lee Counties Water Supply and Sewage Disposal IMFAOVEMENTS PERMIT rio. � Owner: �- ! '` ' 0 pq • Locatio�' � - �1 zp 9 . / p, `"Contractor: ' _ c� � ! iiVater 3upply: Private �, / Public Other disposalfacilitq: No. bedrooms �—�Dishwasher, �Disposal, tpinatic appliances �----- _ :--•- . .__.I /` � �— Nitriflcation Iine• ���' 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 and shall be main- tained by owner in such a manner as not to create a public health hazard. Septic tank and nitriflcation line MUST BE INSPECTEB AND AP- PR,OVEB BY A MEMBER OF THE DISTRICT TH DEFAR.TMENT STAFF BEFORE ANY PORTION OF THE I�7 TALLATION IS �COV- ERED ANI7 PUT INTO USE. % � x ;- � ( � �1 - _. %'� .� G �, r,7.���11,-��. -; � ��� Date approved• Well: Sewage Disposal• Bq• Counter- . signed (Owner or his representative) Cerfiiicate of Completion � • � � . r�� � �'/ Date Approved: B ' S�ni Arian� ��V�,'R) Location of well and sewage disposal facilities sketched on back. � .J .......: ... . - -.. � y �a�e`1 33�� �65 2�7y. ..-- Aod���e�tlorr nats: �' —3 -�10 /�! NWIi O • F••• •.� � • • • \� �^ . � � � O�. . �`�`��.�k .. .� �� �r,�,`� h Tax il�a � , '�� • •�����- ^��.��..� �./ � ` � v ��� ��, - �aa�76 �E'�mrm.]L�lfs. i.'.�_Lii • :.• : �_�ii�_�= � � 1) Pa�dt re�Nas�d bll: (��wn�rra9�f'Pro�v'a owru�: � � l� . ��ui � ��,; �r. d- wt ��_ �n�e�� j�'� • (�'[C� ��;►'- �. Home Phod� 3� `" xI4 -?'��j . � 4rf l � C'r�k lee� ��+hd R�r�n BU8t18s8 Phoil� 3:�/,, - 5�=5 "' D.�p S r�e�tsbe ro. N�?�'�� �' s� �. �� �q� 336`�4 � - 2� P�o� ana �dd�s �e m� owmar: • . _� �- , . �� � . � JtAn TprreZL- Fa"'y 3) �O�rty �ea�tlon: t�t si� 1,1,� Tcw�h��►� n�nJ , Su�SGon: ��'j � Lot� /� Direc�or� b th� ProP�Y (���9 � � . �t .�mcrrl— FF/r»n. /I � '�fht'rL �'icriri-r. �� �rr�tC S�f��/ .i��e 'l�s �o i/`.�- �. %tu�t /?�/_�— �, /� �� rsr� �e �rQ� Ti�c• �.r�, �iMesa- - isia.9y. us� -�,�.s duJ�=fdy ,�- 6.uu �y�. �- �a. i3o�• 4�. a� p��� � �s � �� �� � �. � Z �� 28 �� bj Nurr�er of Bedcaom� ,? Numbe�' ot oa�par� or people tio be �ve�t � ' c) Baaem� Yas _, No �G VI�II tt�e be �hunb�g In the beserr�t? � ' ._ c� Gat�ge D� Yes _, Na � , . � W� �+R�Y }'�1P� Privaaa ✓�(rneuv ,_., ar �g� . P�c._, � �, s� „ Are•eny u+aMe cn adjoin�g p�apecty? Ye�a„ 1+� _ if yee, piease it�be app�trneis loc�tion on �e sf�a p�n. 8� Dcas tiu peop�cly c�n� p� 1d�d Jur�oo�t �4 Yea _ No � PI.EIl9E NOTE TNE FaLLOYY1NG: . '➢ A PU4T OF 71iE PROPi�iTY' OR � PLAN fN9T BE �10TTF.D IARiEI TH{S APPLlCATtON: ➢�OPEii7Y L1NE9 J1ND COR1�91N9T � Cl�AIiLY DiARI�. . ➢.THE L�OP09� LOCAilON OF ALL 9TRUCTURES �iST 8E �i'Al� OR AAC�. • . � THE SffE �11JST BE READILY �I�IBLE FOR API E1IALUAT�N BY TME HEAL.TH D�'!'►i�T1i�If S7AF�. , . . . i• here� n� � tn the Person Caw�ij i-i�ilh Oe�tt iioc a sa�e eveiva�an far the o[t-eiia �wa6+� �P� gY�rn �r the abave�desc�bed property. 1 agree #hat the ccntents af ttti� appii�tion are true and re�r�sent the nmommucn ��a ba plsc�d an th� properiy. 1 unde�and ii #ha s� is �ifies�d ar the � u�e changes, ihe P�i shall . � � • �� . or Legai Rep�re � ' D p�p, �, i�I171D1 ���-�,`� s� ����...� ��� ._._._ . . .� � � -����- ����.� � �.,�-n-�. ����.Il �ZL � �11 �� Tax Map # �� Parcel # � Existing Sewage System Report For. V Mobile Home Replacement Addidon Type: Requester: I C�• Home Phone#�;�`^o s,�_Z� '�{ 7 ` � �. Business # 3�—`�5- t�5� ��'��i'I.��I. - �., � Original Permit Located: Water Supply: �� Septic System Designed For: Y Residential Business Other # Bedroorns `� # Employees Other ���_ Tank Size: itrification Line:��� �� � System Type: l'�ii l`�b��l � �� s- a�- . Date Installed: � - Certified Operator Required: n%b On-site wastewater disposal system shows no visual signs of malfunction on �'d �. Environmental Health Date• ��