401 Elmore Rd (2) u-
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion x
:(Ground Absorption SevyaBe Disposal System - G.S. Chapter 130-Artie e 13C)
OWNER OR CONTRACTOR __eY'_Y q (�r- ��-1,S DATE /o�—,�—��S PERMIT p p
LOCATION ��' z 7 YJJ d• .. 't .`� [� ' ��ma rc�ro, o. O 0 O
SUBDIVISION NAIVE LOT Ido. SECTION OR BLOCK NO.
HOUSE, .MOBILE 11MIE BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BED200r$S 170. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISIMASHER YES ❑ 170 ❑ Four Bedroom House 1000 Gala 1200 Sq. Ft.
AUTO. WA 1L. IIICHINE YES ❑ NO ❑
SIDE ;$LIiiAI;LE YES ❑ NO ❑ �e r es lJ 1 /, .'N( 3 VC)
OF TAIdIC gal. 1
NITRIFICATION FIELD sq. ft. 1- V ^ 9 Z A4,
DEPTH OF,STONE IN LINES:
•o•Z4 ag1 _ YnQr,�Sv,lle .., 4eo&cd
ITATER SUPPLY: Individual Public ❑ l.Ls ,��(', d j '
IIIPROVEInINTS PEWIT BY INSTALLED BY
CERTIFICATE>Or GO,
.PLETIM1 By Date
. (8/16/73) *Construction mus comply with ll oth r applicable State and local regulations
IAT AREA' ' e
ROaex 3AB
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