283 Fork Bixby Rd DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal Sy - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR , DATE /J " PERMIT
LOCATION pYk -- yZ/ il
®l N? 475
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal 400 Sa. Ft.
NO. BE ROOMS a NO. BATHROOMS f Two Bedroom House 00 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 ❑
SITE SUITABLE YES [] NO ❑
SIZE OF TANK �O-D gal. Fb
NITRIFICATION FIELD / Q sq. ft. �e Y
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ M' 7- V5,
IMPROVEMENTS PERMIT BY STALLED BY
--k,
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable state and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground—Absorption--Sewage ;Disposal System - G.S Chapter- 1.30-Arti-cle -1.3G4-
OWNER OR CONTRACTOR f F�� ,./ ° a , �° ; .. DATE t¢" K- `` PERMIT
LOCATION N 475
f�'�`"� r,'"'� -�- ;+ r., ,�' O
S.R. N0. /
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
' i'" House Trailer 800 Gal 400 Sq. Ft.
..,. . I
_ a �W
N0. BEDROOMS ;ter N0. BATHROOMS Two Bedroom House 00-
_GaI 1600 S Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. lO�Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO f
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE -IN LINES:
WATER SUPPLY: Individual 0 Public ❑
IMPROVEMENTS PERMIT BY .a'" `� � INSTALLED BY
CERTIFICATE OF COMPLETION -*
By Date 's ?" ?S
(8/16/73) *Construction must comply with all oth a licable State and local regulations
LOT AREA
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