135 Natalies Way (2) w
DAVIE COUNTYHEALTHDEPARTMENT
nts�Perm
(Septic Tank) Improvemeit and Certificate of Completion
(Ground Absorption Sewage7Dispsal System,, !! G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR .�.Y V+� h �`.S �� ►t� �j+t�C °"��. 1'�� ATE /y)-/,/.— S PERMIT
LOCATION V:�'j`,�✓ c'�' .. �c Ale� �' Ajr 9 485
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 0 BUSINESS ❑
House Trailer 8 al. 00 S Ft.
NO. BEDROOMS c NO. BATHROOMS _ Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO []' Three Bedroom House 900 Gal. 966 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Zr Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑ // �� co�� 3 Z �
SITE SVITABLE YES ❑ NO [3 /r "
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY r��-i'"��-�'.s�r " INSTALLED BY ,TC ,..
CERTIFICATE OF COMPLETION By
*Construction must comply ith all other applicable State and local regulations
LOT AREA
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