2397 Liberty Church Rd r" DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements 716rmit and Certificate of Completion
(Ground'Absorption Sewage Disposal System - G.S. Chapter; 130-Article: 13C)
OWNER OR CONTRACTOR �.', t ; . +, f•�'r rLLDATE PERMIT
LOCATI ON ;, 6 r t C~ �a t. c «� i. r i�ri.�t. l�? 578
C'.. Nt PL S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq.- Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 8 0&q--F,t
GARBAGE DISPOSAL UNIT YES ❑ NO :0.. Three Bedroom House X00 Gal 90 .. Sq. Ft.
AUTO. DISHWASHER YES ❑ NO 12 Four Bedroom House 1000 Gal. 1200 Sq.
AUTO, WASH. MACHINE YES ❑ NO 0
t a
SITE SUITABLE YES [3 ❑
NO '. t"�a,�.• iR :."C`r� `�" "r
SIZE OF TANK gal. Cl
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTSPERMIT BY n INSTALLED BY
CERTIFICATE OF COMPLETION By f Date z.,'"
(8/16/.73) *Construction must comp /With other applicable State and local regulations
LOT AREA
1,14
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