P1222 Mr Henry Rd DAVIE COUNTY HEALTH DEPARTMENT 1142 r/42y 0,
(Septic Tank) Improvements Permit and Certificate of Completion
UPe" (Ground Absorpt on Sewage Disposal System G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE PERMIT
LOCATION 1222
Aid—
S.R. N0.
SUBDIVISION NAME LOT N0. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS __ NO. BATHROOMS _ Two Bedroom House 800 Gal. 600 S t.
GARBAGE DISPOSAL UNIT YES ❑ ISD Three Bedroom House 900 Qal. 900 Sq. Ft.
AUTO. DISHWASHER YES Ua NO ❑ Four Bedroom House 1000 Gal 1200 Sq. Ft.
AUTO. WASH. MACHINE YES dr NO ❑ re
SITE SUITABLE YES ❑ NO ❑ �S /t f ��D
SIZE OF TANK gal.
• .
NITRIFICATION. FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY Individual Public ❑ I`
IMPROVEMENTS PERMIT BY t INSTALLED BY
CERTIFICATE OF COMPLETION By � � Date a
(8/16/73) *Construction must comply' with Al other applicable State and local regulations '
LOT AREA ,
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