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.i The District Health Department <br /> C Orange. Person, Caswell, Chatham, Lee Counties <br /> V <br /> SEPTIC TANK PERMIT <br /> -4Dat -- <br /> Na of owner <br /> dAddress and Directions <br /> Person or firm doing i stallation: <br /> Address <br /> No. of persons to be served bedrooms 1, 243 4. <br /> Additional appliances to be used: Disposal, dishwasher, washing <br /> machine <br /> Minimum Requirements: Septic tank <br /> Nitrification line: 41 <br /> Septic tank and nitrification line must be inspected and approved by <br /> a member of the Health Department staff before any portion of the <br /> installation is covered. <br /> Date Approvedl;;- 31r <br /> P <br /> Sanitarian <br /> By: -A <br /> O. David Garvin, M.D., M.P.H. <br /> District Health Officer <br /> Countersigned <br /> (Over) <br /> 257 <br />