270 McClamrock Rd DAVIE COUNTY HEALTH DEPARTMENT
ASeptic Tank) Improvements Perf it.rAd; ertilic ..pf._Completion ~�
(Ground Adsorption 'Sewage�D:Lsp.6sal_Sy&tem._- G..S.. Cha4zter.�130-Article 13C)
OWNER OR CONTRACTOR ,--:+'( %X: w.c ; '" �_,,,r v.,, --DATE . 'r:- s ).. -- PERMIT
LOCATION
S.R. NO.
SUBDIVISION N LOT N0. SECTION OR BLOCK NO.
HOUSE s MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gala 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House. 800,Ga1 600,�,Sq,`Ft.
.GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 0 Gaj ' 0300Ij
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 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual [1 Public ❑
IMPROVEMENTS PERMIT BY i +rf' %: r - :*<, r INSTALLED lBY ��GLy•c, ST L' O .
CERTIFICATE OF COMPLETION
BY Date-
- *Construction must AM4446CM applicable State and 1oca �aoT�s
LOT AREA
91
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