190 Valley Oaks Drive Lot 12 DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Dispos 1 System - G.S. Chapter 30- ticle 13C)
OWNER OR CONTRACTOR 7+�'�-d .,C'� LA DATE -^',�''� `"9 PERMIT
LOCATION N9 1259
S.R. NO.
SUBDIVISION NAME l ` » rE 94 k.S LOT NO. G SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS w,, NO. BATHROOMS Two Bedroom House 800 Gal. 600_S t.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House J 900 Sg. .
AUTO. DISHWASHER YES yE,__ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Q NO ❑ j lwy .,L � ` f
SITE SUITABLE YES Eff"'N 0 ❑
SIZE OF TANK gal.
NITRIFICATION FIELD t 00 sq. ft.
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DEPTH OF STONE IN LINES: ,
WATER SUPPLY: Individual Public '
IMPROVEMENTS PERMIT BY INSTALLED BY
CERTIFICATE OF COMPLETION
By Date -�
(8/16/73) *Construction must comply wi't" aT " tither applicable State and local-' regulations
LOT AREA
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