119 Dogwood Lane Lot 154-16144PM DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt onSewageDis osal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR / t t ! ; r :' "� D ',; ' 1 % 7 PERMIT +�
LOCATION u:f�ri r, t _ '.,.,� ,:? s`° } .�r L�-�'..a� . Y ,�`a ��' 1\� 1948
/ S. R. NO.
SUBDIVISION NAME,jUQQ(,�lan j,1 LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ 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:
i"
WATER SUPPLY: Individus_1 ❑ .,-public ❑
IMPROVEMENTS PERMIT BY :! ,1, r ( lC 7
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 House 1000 Gal.
1200
Sq.
Ft.
INSTALLED BY��=
CERTIFICATE OF COMPLETION
By f 1, r Date /n h
(8/16/73) *Construction must comply with all oth6r applicable State and local egulations
LOT AREA
,,max a