P11 Liberty Church Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Abso�o�age isposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE `a PERMIT
LOCATION f o2 NU
S.R. NO. /43 (0 oZ
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE- ❑ MOBILE HOME BUSINESS ❑
a77 ;less 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.
NITRIFICATION FIELD DO sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ DtrL 11" S
IMPROVEMENTS PERMIT BY INSTALLED BY f
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must compK with all other applicable State and local regulations
LOT AREA
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