620 Gladstone Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-AFticle 13C)
OWNER OR CONTRAC`tOR' \f.' A/y /y1mo -p—, DATE 4/_ e - PERMIT
LOCATION476
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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
c Q� 6 0 0 . t_.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑" Three Bedroom House x900 Gal.; 900 F Sq Ft
AUTO. DISHWASHER YES NO Q'- Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES C7 NO ❑
SITE SUITABLE YES '❑ NO ❑ 'S /w" �:.r N e-
SIZE OF'TANK Q gal. y ,�¢�-yz ns
NITRIFICATION FIELD �en sq. ft. L`�d 'f ��A� (� -f ,r r
DEPTH OF STONE IN LINES: f " A�r�� ``/ r^ �k � ��
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WATER SUPPLY: Individual" Public
IMPROVEMENTS PERMIT BY :!', ! "� �.. INSTALLED BY �pC
CERTIFICATE OF COMPLETION By ( �"� Date
(8/16/73) *Construction must omply with all other appli able State and local re tions
LOT AREA
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