P1028 Pete Foster Rd f/
DAVIE COUNTY HEALTH DEPARTMENT
(Septic"Tank) Improvements Permit and Certificate of Completion
(Ground Absorption .Sewage Disposal System- G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE =M �-`'' I!n PERMIT
LOCATIONC"� � ( � �tt: �,,.�.4_� ;_, �, _ ..! l..r..T '� N? 1028
(tv. c. ifetr• ( it i ..i `t i.; r I t - S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gala 400 Sq. Ft.
NO. BEDROOMS if NO. BATHROOMS Two Bedroom House 800 Gala 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 ❑ 14��Q c
SIZE OF TANKc''�SaDga l.se-114 /C c
NITRIFICATION FIELD Joy sq. ft.
DEPTH OF STONE IN LINES: �8�� �►'����'
WATER SUPPLY: Individual �� Public ❑
IMPROVEMENTS PERMIT BYINSTALLED BY ��
CERTIFICATE OF COMPLETION BY ll Date
must
(8/16/73) *Construction a
other applicable State and local regulations
LOT AREA �' � : c jC� �` � . `if' '' brvc t
In
j� It.