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The District Health Department <br /> Grange,Person, Caswell, Chatham, Lee Counties <br /> SEPTIC TANK PERMIT <br /> Name of owner: <br /> to Name of contractor: <br /> V <br /> Address and Directions <br /> Person or firm doing install on: <br /> Address <br /> No. of persons to be served" - . Bedrooms 1 3, 4. <br /> Additional appliances to be used: Disposal, dishwasher, washing <br /> i machine <br /> Recommended: Septic tan -011 <br /> Nitrification line: <br /> Above recommendation ba d on information received and observed <br /> soil condition. Septic tank and nitrification line must be inspected and <br /> approved by a member of the District Health Department staff before <br /> any portion of the installation is covered. <br /> Date Approved: <br /> �. � <br /> Signed <br /> Sanitarian <br /> By: <br /> O. David Garvin, M.D., M.P.H. <br /> District Health Officer <br /> Countersigned <br /> (Over) <br /> 253 <br />