P296 Country EstatesDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(':round Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR _ .r s cnnt.A P, t #-�� \` ` DATE iia - • Z PERMIT
N° 296
LOCATION "'�-..., �. n c i. j w...t1 dF�,euSe. [tri R,4i r 4)f,S7-
ZM, ,, a.n. Nu.
SUBDIVISION NAME (�nt� i r.. 92MMS LOT NO. SECTION OR BLOCK NO.
HOUSE X MOBILE
HOME
I1
BUSINESS ❑
NO. BEDROOMS 3
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO ❑
AUTO. DISHWASHER
YES
❑
NO ❑
AUTO. WASH. MACHINE
YES
❑
NO ❑
SITE SUITABLE
YES
❑
NO ❑
SIZE OF TANK 9CV gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public'
IMPROVEMENTS PERMIT BY lZs,� } N -e, -An
House Trailer 800 Gal.
Two Bedroom House 800 Gal.
Three Bedroom House 00 Ga
Four Bedroom House 1000 Gal.
INSTALLED BY zp���,(, c`a."'C� i_x�•
400 Sq. Ft.
600 Sq. Ftp
1200 Sq. Ft.
CERTIFICATE OF COMPLETION
BYC fA Date ;
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA
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