181 Richie Rd 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 :� z +«.. �, .. r4A ! DATE `�+.;+�°:..1,�'�'"" PERMIT
LOCATION £ j11 " . . � lr 619
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME .. BUSINESS ❑
N0. BEDROOMS House Trailer 800 Gal. 400 Sq. Ft.
- '-- N0. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Q Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ;❑ NO "' Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES, ❑-''ANO ❑
SITE SUITABLE YES [;-"NO ❑
SIZE OF TANK / _ gal.
NITRIFICATION FIELD " _4"""' sq. ft.
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DEPTH OF STONE IN LINES: /'� #,,%o ! d C�f ^4 J 0
WATER SUPPLY:- Individual
j ❑ Public ❑ / I
IMPROVEMENTS PERMIT BY `1! x •. INSTALLED BY
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with a 1 oth ap. cable State and local regulatio' s
LOT AREA
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