P417 John Crotts Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion rC
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR �'irt;:r, tF t>fi "xz,*i.a DATE PERMIT / h�
LOCATION C11. it C' e c�- �I):t�'Z` � : f�,., ie 1 i 1�O �� `t 1
S.R. NO. Iia;.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑ �_
House Trailer 80 1.� 400 Ft.
NO. BEDROOMS NO. .BATHROOMS Two Bedroom House 800 Ga 600 3 .
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House ;. 9 0 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 ❑
SIZE OF TANK gal.
NITRIFICATION FIELD /%c?" sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY Individual Public ❑
IMPROVEMENTS PERMIT BY �: '. 11`Y ,.F;,, tZ INSTALLED BY
CERTIFICATE OF COMPLETION By 1"y�Cc�..r�t Dated
(8/16/73) *Construction must c ply with all other applicable State and local regulations
LOT AREA
X01