1977 Liberty Church Rd DAVIE COUNTY HEALTH DEPARTMENT
s (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR DATE //-' -71, PERMIT
LOCATION 6 f AI /,. i �. %i�' l �- ti ! ., w� C �_` : w• t. NO 1185
}'M_;, ... ; ' ! ri <<•r� S.R. NO. S,,R, 1313
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
. � House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS , 0. 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 ❑ Y
SITE SUITABLE YES ❑ NO ❑ i '`
SIZE OF TANK 0 gal. L ...'. { ? . i .. A) ��-
NITRIFICATION FIELD Iry sq. ft. 7, ` 'k
DEPTH OF STONE IN LINES: teuct
WATER SUPPLY: Individual Public ❑ C - - - - ---- ..._
IMPROVEMENTS PERMIT BY �'� tQ, fN'Nr24,Jt5 INSTALLED BY
CERTIFICATE OF COMPLETION By �Yy Date �/- IS 74
(8/16/73) *Construction must omply with all other applicable tate and local regulations
LOT AREA
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