401 Elmore Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Artilcl.e-13C)
OWNER OR CONTRACTOR j_e_Y_V'y r e c'j s DATE /07 PERMIT p
LOCATION t% d< 'L : C� �l�,o o rod �� S 0 0
NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE M MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. -Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. .WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ e Y' /�� � o !n�{d�l•'ir� 3 S�
SIZE OF TANK gal.
Av�Y��e � 9z -lw�h
NITRIFICATION FIELD sq. ft. 90 S„ ,F
DEPTH OF STONE IN LINES: r `� �i�/��S !O�ZC' x l�.``too e l•
3,o-tot agt _ ►',', 5�,Ue. Lev&
WATER SUPPLY: Individual Publ c ❑ GGse�r"r
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION] By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
CZoo'X
1
f
Ell ,
s
0 , r t