5102 Hwy 158 t DAVIE COUNTY HEALTH DEPARTMENT
y^ • (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTO _ " DATE —oZS=°�� PERMIT
LOCATION [.t) ? 837
S.R. NO.
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 Gala 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q NO ®/ Four Bedroom House 11000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ( N0 . ❑ ll
SITE SUITABLE YES NO [3v�� Zed 1C 1� 2d
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 9 Public ❑
IMPROVEMENTS PERMIT BYi / INSTALLED BY
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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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 CONTRACTORt ��,A,,cLtP -,_-k D44�� DATE 5? PERMIT r
LOCATION Lt,� j lr 837
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME tj 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 90 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q NO [ / Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ( NO ❑ G /��)v
SITE SUITABLE YES 03-'No [3 w C3
SIZE OF TANK gal.
NITRIFICATION "FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: ,-Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
fz
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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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 CONTR/ACTOR;� .�L,.,::y :._{ � DATE PERMIT
LOCATION `�'�G t l r r �� , N? 837
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 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House . 90Qw Gal. _900_Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Q Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Lam''" NO ❑ - r ��
SITE SUITABLE YES [M- NO ❑ c'�,� 't''�1�l :}J (' `: J .l';
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA