188 Joe Myers Rd DAVIE COUNTY HEALTH DEPARTMENT
eptic Tank) Improvements Permit and Certificate of Completion
Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR """"�"-` (��, # � � DATE �>- PERMIT
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LOCATION c� k C`r t t.r,~� t : �t�.� tQ._ 4 r C i +i'i �� 1\ . 574
S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 54 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. ' -'90"USq. Ft.
AUTO:,'DISHWASHER YES ❑ NO [ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES [P" NO ❑
SITE'.SUITABLE YES Imo'" NO ❑ "
SIZE OF TANK q,to ,,.---gal. �,_ i r-• 3 t,
NITRIFICATION FIELD K sq ft. J -
DEPTH OF: STONE :IN LINES:
WATER SUPPLY. ` Individual ,` � Public ❑
IMPROVEMENTS 'PERMITI.BY INSTALLED BY 9�
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CERTIFICATE OF COMPLETION
By Date-M-111" �1S
(8/16/73) *Construction must compl ith all other applicable State and local regulations
LOT AREA �;.�a t #c,
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