182 Cottontail Ln (2) 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 �dJ;/ i�t4:,#0/1r;- Art Al DATE'-3- '7 j"' PERMIT
LOCATION• t t
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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 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO not, 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 ❑ • .ter
SITE SUITABLE YES NO ❑'
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individua [Public ❑
IMPROVEMENTS PERMIT BY DtAAL., �.• �� INSTALLED BYQQ S.�. Ga•
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CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must com y with all other applicable State and local regulations
LOT AREA
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