P90 Sanford Ave DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption S`ewageDisposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR i _��.�t'-^.,�,z G: ' DATE ,,? ,- PERMIT
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LOCATION r-�•:. �x�.�:- . ''-_; ��_��_�-�? 90
!/ S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE , MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 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 ._�_. ES ❑ NO ❑ w•( 'C°'z
SIZE OF TANK gal. o �
NITRIFICATION FIELD ,,,Z sq. ft.
DEPTH OF :STONE IN LINES: �P 12 ��
WATER SUPPLY: Individual /❑'} Public ❑ /
IMPROVEMENTS .PERMIT BY1� 1 / / ;s tA_ .° INSTALLED BY
IN
CERTIFICATE OF COMPLETION BV Date
(8/16/73) *Construction must coialytAith all other applicable State and local regulations.
LOT AREA
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