839 NC Hwy 801 South Lot 4 Section 2Y , DAVIE COUNTY"IIEALTH DEPARTMENT
y (Septic Tank) Improvements Permit and Certificate of Completion
(Ground At>i;3orption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOTtti+`;'{g,�, r}�r`;pA DATE,PERMIT
LOCATION d)-- �k , ; �r*;+�.. �S / V �O �S N9 597'
S. R. NO.
SUBDIVISIONAME ; , ' . - LOT NO. ' SECTION OR BLOCK NO. +i, -4— CrlA .
HOUSE" `HOB=lOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS ,,.
GARBAGE DISPOSAL UNIT' YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: IQ`s
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY %,7)- a -Aa
House Trailer. 800 Gal.
400 Sq. Ft.
Two Bedroom House 800Gal. 600,- Sq Ft..
Three Bedroom House 900 GGa�1 ), '900
__
Sq Ft:.
Four Bedroom House Gal.
�L00 S"q. Ft.
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INSTALLED BY —ji%j
CERTIFICATE OF COMPLETION By Date lo -7- -/6—
(8/16/73) *Construction must c ply with all other applicable State and local regulations
LOT AREA .� ..
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