3492 Hwy 158 (2) DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) hnprovements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR
tt rt-..41 rt .�r. �\� ',ls .:"t �f..:r-y,i,�t�, DATE A PERMIT
LOCATION 1,.,,,, J ti" Nr�? 8 0
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME .❑
�rcd.. House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. 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 ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
A.
SITE SUITABLE YES ❑ NO ❑ t3 t��
SIZE OF TANK gal. 14all - 3, E,rs"tI� rcao>�S
1�.
NITRIFICATION FIELD sq. ft. f O
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION
�(Y�rs..�"� Date 0-2,'7 G
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA
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