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The District Health Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Se�wage Disposal
IMPROVEMENTS PERMIT No.
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Owner: �i�� ��ii'V1 Vl ���� ���-6Ei�-�-
Location: ��
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Contractor: � - �` � �%tM�
Water Supplp: Private 1��I Public
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Sewage Disposal Facilities:'No. rooms ,�L Dishwasher, Disposal,.
' aclii other auto�natic appliances 't �
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Size of tank: ���`�' �� �"' - � Nitrification line: � � � X �
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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 in such a manner as not to create a public health hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVED BY A MEMBEft OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE I1�S�.' f�LATION IS COV-
ERED ANB PUT INTO USE. �• /' �1 ;
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Date approved: Signe.'d �� �f y
Sanitarian �
Well:
Sewage Disposal: � I Counter-
BY: signed
(Owner or his representative)
Certificate of Completion �
Date Approved: '� � By: � -� '
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(OVER)
Location of well and sewage disposal facilities sketched on back.
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NOTE: Make sketch of installation showing lot size and s,hape, location of house, septic tanks, privies, water
supplies, . Note special problems existing on lot. Write in measurements in order that installations may be located
at later�e. Note lo ation of water supplies on adjacent lots. •
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