487 Ben Anderson Rd (3) DAVIE COUNTY HEALTH DEPARTMENT
' (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR S +J�"!t� T'' J.i C� 1"' DATE � `,7_-7t, PERMIT
LOCATION Al . ► Doi b
1. re} , L a,.j CA k Ct N? 648
, t S 3 or./ *S.R. 'N0. Z..
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS �_ Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ( Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ,❑., NO 931-- Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES r10 ❑ .
SITE SUITABLE YES bNO ❑ { / .
SIZE OF TANK ".? gal. Alita/
NITRIFICATION FIELD OC) sq. ft.
DEPTH OF STONE IN LINES: i !!�f► vtc�+�tr � �
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comp with all other applicable State and locariZlrudEfons
LOT AREA '
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