807 Peoples Creek Rd DAVIE COUNTY HEALTH DEPARTMENT ' d r�� "/
' (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR 7A PJ. F O Ict ttir +x.V DATE PERMIT
LOCATION ��'i••, 4n t toms'�7 lll��. �.0 j�v ��c�' S l� 3� r "? 904
taN 1.. . sa .la€a � t wiGF S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
N0. BEDROOMS ,, NO. BATHROOMS
2""
"" Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO L�3' e B unt'-g�....� maignn c„ at-
AUTO?--ZISHWASHER YES ( NO ❑ Four Bedroom House. 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES l NO ❑ �'` �iID An
SIZE OF TANK gal. L J
NITRIFICATION FIELD a® sq. ft. w--
C' tai+u
DEPTH OF. STONE IN LINES: ., <
WATER SUPPLY: Individual 19"ublic ❑
IMPROVEMENTS PERMIT BY ��% ��. INSTALLED BY ,y
CERTIFICATE OF COMPLETION
By ' Date
(8/16/73) *Construction must co y with all other applicable State and local regulat'o s
LOT AREA
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N w 4,j R r«r l l+Ri S I N �l �. V;; +I $ .
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