P857 Poor Boy Trail DAVIE COUNTY HEALTH DEPARTMENT 7 OQ/Ll�/Svav
• (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR "fi3,.. ., tpn� ':�,� DATE ,T.,. �A'"JCr: PERMIT
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S.R. NO. IIsi
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS T edroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 0 Thre d oom House 90 Oal. "900 S . Ft.
AUTO. DISHWASHER YES Q' NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES 0 . NO ❑ � J
6 r
SIZE OF TANK gal.. ;t'/�r��ry«�,�'y lrme
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY t . S'i'�rr"k\6 INSTALLED BY
CERTIFICATE OF COMPLETION By� ,� Date 7-
21-76
(8/16/73) *Construction must mply with all other applicable State and local regulations
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