P767 Farmington Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal. System - G.S. chapir-h". 30LArticle 13C)
OWNER OR CONTRACTOR _ r. a� - ` (��b '. p�„r;""Q' DATE ja +`lfr,=7j"`' PERMIT
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LOCATION — A.e + .-e +rV . L�� ..
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lSk- 440'.-M 'aj.- 'Lalp. - S.R. NO.
SUBDIVISION NAME LOT NO. . SECTION OR BLOCK NO.
HOUSE MOBILE HOME ,E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS NO. BATHROOMS _ Two Bedroom House 800 Gala 600 Sq. Ft.
GARBAGE .DISPOSAL UNIT YES C! NO ❑ Three Bedroom House . 96 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ($' NO ❑ Four Bedroom House 1200 Sq. Ft.
AUTO. WASH.`MACHINE YES NO ❑
SITE SUITABLE YES, "' NO ❑ 5� i
SIZE OF 'TANK 900 ga 1 &'�'''/ �,, -C- ,
NITRIFICATION -FIELD �D3 �� ! �` �, � ���+� '' h`�'�' ��,.e. �'��:
q x� 4�
DEPTH OF STONE IN LINES: ffk�h'`�k" {w J
WATER SUPPLY: ; .Individual Public ❑ ,�� r�
IMPROVEMENTS PERMIT BY '��°V�:w r, . ,. INSTALLED BY �
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) , *Construction must compil with all other applicable State and local regulations
LOT AREA `!�. i�t c 3
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