181 Boger Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit- and,Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter l"30-Articl`iF13'�)
OWNER OR CONTRACTOR c: s y' 1 + DATE .•• � �� PERMI
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LOCATION rw .. s"' .1 .." J\? 260
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P_u S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS ' House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 8jD—C.3.1. 60.0.;.Sq--fit,,._
GARBAGE DISPOSAL UNIT YES El NO ❑ Three Bedroom House. 000 GaJ t t r9000�Sa.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK ,�l-4 gal.
NITRIFICATION FIELD ! sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: In#yidual Public ❑
'�:.,°, r INSTALLED BY
IMPROVEMENTS PERMIT!' •�.,r:,-:'. � Mr^,QhS
CERTIFICATE OF COMPLETION By j Date
(8/16/73) *Construction must corn with all other applicable State and local regulations
LOT AREA
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