5203 Hwy 801S DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground AbsorptJon ewage`Di�f�9sa1�S stem - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR r, -x�?—rr��'F�,:�—y, `'�� .� " DATE PERMIT
' N° 486
LOCATION 0/ , ' v°t r v r 'c.4-) f i ,!V°CS
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE 91 MOBILE HOME BUSINESS ❑
-+ �t House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS
, Two Bedroom House a t
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House
AUTO. DISHWASHER YES NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑ v? !' �, r r
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual jPublic ❑
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
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