368 Ben Anderson Rd (2) T 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 CONTRACTOR "'i,•• ., DATE f PERMIT'
LOCATION 'c.ct r eL N9
546
4 Y{ 1 .i» i rU'.:r a �'� • C y" S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 80�•••.aal. 4'00--Sq--,Ft.
N0. BEDROOMS 112 NO. BATHROOMS Two Bedroom House 800 Gal- ''`600 Sq..Y Ft.:'
GARBAGE DISPOSAL UNIT YES ❑ NO R Three Bedroom House900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO, WASH. MACHINE YES NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANKgal.
NITRIFICATION FIELD orl sq. ft.
DEPTH OF STONE IN LINES: P,tirf
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY .W, 'dAtS
CERTIFICATE OF COMPLETION BY , b Date S �S
(8/16/73) *Construction must omply with all other applicable State and local regulations
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