138 Brookdale Road Lot 12 P/O 13 Section 2I 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 i � i : DATE !�-•- .T: ---74-PERMIT
_Q N° 35
LOCATION': - 1- Qk.P (J rJ Iz- % �° �-Qe-
S.R. N0.
J
SUBDIVISION NAME &fOC 4_,J •;r is w tL'e° LOT NO. % e SECTION OR BLOCK N0.
d�
HOUSE MOBILE HOME BUSINESS ❑
NO. BEDROOMS NO. BA OOMS
GARBAGE DISPOSAL,UNIT YESNO ❑
AUTO. DISHWASHER YES Q O ❑
AUTO. WASH. MACHINE YES2�'NO
NO ❑
SITE SUITABLE YES ❑
SIZE OF TANK 10 o o gal.
NITRIFICATION FIELD . 14r;r _ sq. ft.
DEPTH OF STONE IN`LI�ES:
WATER SUPPLY: Individual �.� MPublic
IMPROVEMENTS PERMIT BY
House Trailer
800 Gal.
400
Sq. Ft.
Two Bedroom House
800 Gal.
600
Sq. Ft.
Three Bedroom House
900 Gal.
900
Sq. Ft.
Four Bedroom House00
al.
1200
q.
❑ P
.�� INSTALLED BY
CERTIFICATE'OF COMPLETION f !
(8/16/73)
LOT AREA_
By Date
*Constructionmust com 1 ith all other applicable'State and local regulations
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