141 Pineville Rd mow.
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewa a Disposal System - G.S. Chapter 130-Article- 13C)
OWNER OR CONTRACTOR , C'd h Ct i C I�}i t r'7.Yt 1*,U 5 DATE d- - �J � PERMIT
LOCATION4--
/;r X0 lr� 1410
.t. S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSEMOBILE HOME BUSINESS ❑
House Trailer 800 Ft
NO. BE ROOMS NO. BATHROOMS �... Two Bedroom House 800 G ,
GARBAGE DISPOSAL UNIT YES ❑ NO [ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Q'' Four Bedroom House 1000 Gal. 1200 Sq. Ft.
'
AUTO. WASH. MACHINE YES ❑ . NO ❑ -% ,r
SITE SUITABLE YES ❑ NO ❑ � � .y,V�'S
SIZE OF TANKS gal.
NITRIFICATION FIELD 6 .3 0 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY �''`' . .' %� NSTALLED BY
_T
CERTIFICATE OF COMPLETION
BY-1CI� Date / '�5' 77
(8/16/73) *Construction must 61omply with all �other applie--le State and local regulations
LOT AREA
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