170 Mortgage Hill Way (3) 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 10— 7t;' PERMIT
LOCATION ~> � —r�1 'rou l �op"Or s ��lh� 1 r f� A� Lx��`t; is � N? 581
l.zacCd,t - �« ;; l� -� ;G ,j S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME t4 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 al. 6�00- t.
GARBAGE DISPOSAL UNIT YES ❑ NO 0 Three Bedroom House00 GaSFt
AUTO. DISHWASHER YES ❑ NO (a Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ® NO ❑
SITE SUITABLE YES FZj NO ❑
SIZE OF TANK CA 0 Q gal.
NITRIFICATION FIELD Co 0 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY SoF YYIA acl4 ,M INSTALLED BY
CERTIFICATE OF COMPLETION BYnCso. ti Date
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA i n o + r�r g F-s
1•:,�,1:
tt
MF
Si
C,J
�t