200 John Ijames Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
• • (Septic Tank) Improvements Permit and Certificate of Completion
(Ground AbsorZtion Sewage- DisJ;)-Ye_
sal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR ^0%-e�•e DATE «.J J-7& PERMIITT
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LOCATION le -, t 4 i lr? 650
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SUBDIVISION NAME OF LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. 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 Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 93--'NO ❑
SITE SUITABLE YES 0--140 ❑
SIZE OF TANK e',"F' 0 gal.
NITRIFICATION FIELD e` sq. ft.
DEPTH OF STONE IN LINES: 9 %V, 1- �/
WATER SUPPLY: Individual '""Public ❑
IMPROVEMENTS PERMIT BY1?0/1-*,1L-.. ` , INSTALLED BYJX
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA
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