169 Pineville Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
K,
(Septic Tank) Improvements"Permit and Certificate of Completion
(Ground Absorption Sewage, Disposal System - G.S. Chapter 130-Article 13C)
OWNER 0R&-CONIR2ACTOR !' '' DATE c'r ' ''"'" f' PERMIT
N° 285
V LOCATION ,".• ;�, s ;F. �,..
S.R.. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
r. House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS N0. BATHROOMS Two Bedroom House. 8p,11-Ga 6g•1_S4-...,..Eta
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House "900 Ga' 0 ��'
r:..,,.,-$. .
AUTO: 'DISHWASHER YES ❑' NO ❑ Four Bedroom House 1000 Gal. 1200 .S,q. Ft:
- AUTO. WASH. MACHINE YES ❑ NO ❑1 .
j
SITE SUITABLE YES ❑ NO t❑
SIZE OF TANK r.r gal.
ff ... ., t . <. ._ S 1 J
NITRIFICATION FIELD ' " sq. ft. t, •.. ;,. Off
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
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IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETIONBy Date
"
(8/16/73), •. *Con'struction must co ly with' all other applicable State and local regulations
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