273 Hearthside Ln DAVIE COUNTY HEALTH DEPARTMENT
1 (Septic Tank),Improvements-Permit and Certificate of Completion
(Ground Absorpgon Sewage Disposal System - G.S. Chapter 130-Article"A30)
OWNER OR CONTRACTOR ' c ; ;C. �.. :�+ DATE %1 17-7 PERMIT
LOCATION ' �'I< < > 4 , '� € . i i �_ ,«.. N° 13 71
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS NO. BATHROOMS s Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER ' YES Q NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES CT NO ❑ �nC
SITE SUITABLE YES .❑ NO ❑ �' ` `' d �''
SIZE OF TANK .�.:�2%`� gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual N Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY' Alq
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CERTIFICATE OF COMPLETION '
By ` Date �
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREAS
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