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The District Health Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply and Sewage Disposal
IMPROVEMENTS PERMIT No.
Date -
Owner:
Location: r� Q U C'- ts-�O r
�z 13�
r ZA'�
p, Contractor:
�
� Wate: Supplp: Private Public
Sewage Disposal Facilities: No. bedrooms Dishwasher, Disposal,
washing machine, other automatqic appliances
Size of tank: �/���% � 1°. Nitriflcation line:
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 an3 shall be main-
tained by owner in such a manner as not to create a public heaith hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY POftTION OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE.
Date approved: Sig ��fL�
Sanitarian
Weil:
Sewage Disposal:
By:
Counte - -
aigne ����
(Own or his representative)
Cerli�icate o� Completion `����V"""'
Date Approved: -�� By'
' Sa arian
(OVER)
Location oi well and sewage disposal facilities sketched on back.