130 Hepler Rd (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 rt z ;..,,r, DATE .,T-,:,�/`7.`� PERMIT
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LOCATION h lr 9'{` ti. t 1 o v r, ► c c�,�: - ..1.. ��i A f`,t ` C�`;, 1 � �c� � 567
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
-► House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS L NO. 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 ❑SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD ;a.T sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY c�� ���,,�.;�„� INSTALLED BY �R►.NK��A 1J 5 e w
CERTIFICATE OF COMPLETION ByDate� �� &-:3- 7X
(8/16/73) *Construction must c mply with all other applicable State and local regulations
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