4250 Hwy 601N (2) • DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption S wage Disposal System - G.S. Chap130-Article 13C)
OWNER OR CONTRACTOR DATE te r9�PERMIT
LOCATION N? ( 14
S.R. NO.
SUBDIVISION NAME -77h, 1-3 LOT NO. SECTION OR BLOCK NO.
HOUSE [I MOBILE HOMEBUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS 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 ❑ DIS CPN.vec
SIZE OF TANK gal. , I
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
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WATER SUPPLY: Individual ❑ Public ❑ Tr/r. 41-
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must o pl with all� othei ap able St to and local regulations
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z Z , 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 DATE PERMIT
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LOCATION jr `r�
1 4
S.R. NO.
SUBDIVISION NAMEJy. . , LOT N0. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 0 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS 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 ❑ S1tNlT� �,ti
SITE SUITABLE YES ❑ NO ❑ �l$-CpNAJL'Gq o6•tiSY YdM
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ro
.,,,'�''�waGc ��S osa�
WATER SUPPLY: Individual ❑ Public ❑ 7A. 0 Z.. N� '
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION BY Date
(8/16/73) *Construction must comply with all other appl able State and local regulations
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