5269 Hwy 158 DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption,bewag4/ Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR I(r�Ji � t (�,-„S DATE <�-'..'` T
. _� PERMIT
LOCATION �.��. '�t ��- l\ L�
-$ S.R. N0,
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS
7 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 ❑ _
SIZE OF TANK gal. " , Y' .� L"' r►,�7�i�� C' C.±
NITRIFICATION FIELD sq. ft. �r��s
DEPTH OF STONE IN LINES.
WATER SUPPLY: Individual ,, ,
Public ❑ t ze
IMPROVEMENTS PERMIT BY INSTALLED BY,,-I, ,
CERTIFICATE OF COMPLETION
By
,. --��-,`'". Date 74f
(8/16/73) *Construction must co y with all other applicable State and local regulations
LOT AREA
,j i
I� s
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption ,Sg
_ewag Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR '`�i DATE i `f�r•PERMIT
�To P�
LOCATION 1\ . 4
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E3 BUSINESS
?k 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 ❑
SIZE OF TANK gal. f' &- ^P/a$, t- c--s
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: I ire '1
WATER SUPPLY: Individual ..# Public El '
IMPROVEMENTS PERMIT BY c; . ;' -�•'- �• '�. INSTALLED BY �W ,t
CERTIFICATE OF COMPLETION By , / r,,,, Dat —4-- J �
(8/16/73) *Construction must citiWly with all other applicable State and local regulations
LOT AREA
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