585 Boxwood Church Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank),Improvements Permit and Certificate of Completion
(Ground Absorption Sewage ,Disposal System_7 130-Article-4-31f)
OWNER OR- COIi'M13TOR- � ;�* +t�" /" ice„ t k+ M't DATE �yZ f•• RMIT �y
LOCATIONti�"s:... f �� 3.(
S.R. NO.
SUBDIVISION NAME LOT N0.
SECTION OR BLOCK NO. {'
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 al. 40 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS Two Bedroom House 800 00 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 0'' ,, Three Bedroom House 0 Gal: 0 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Ga Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES ( NO ❑
SIZE OF TANK / gal.
NITRIFICATIQN FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY t,,. INSTALLED B `
CERTIFICATE OF COMPLETION
BY k Date+-T����-
(8/16/73) *Construction mus o y W"i a of er licable State and local regulations
LOT AREA
.,..--
A
Vc
1,14