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189 Random Road Lot 4AY✓ DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absor ion �S�ewa a Disposal-Sy�7sVtemy,, S. Chapter 130 -Article 13C), OWNER OR CONTRACTOR �L� /Yl �W' `64 F r- L�10tATE A/:JY,''l iiPERMIIT /�pq LOCATION y.� .y . r�/. �^ �a r {'/F �� f ' /`� � / a �.� �J 17 i 1• h 7w� s N 981 C D N SUBDIVISION NAME . %� `. •`7 - I ('.S' LOT NO. [ SECTION OR BLOCK N0. Dated (8/16/73) 400 Sq. Ft. HOUSE ❑ MOBIL E;HOME:.• BUSINESS ❑ House.Trailexr. 800 Gal. NO. BEDROOMS ? NO. BATHROOMS Two; Bedroom House 80QLal,j 6QLS(j ,Ftp GARBAGE DISPOSAL UNIT YES ❑ ..NO ❑ Thre, Bedroom House e 1900 Gal.) i000 902--S-9--MU AUTO. DISHWASHER YES ©""-NO ❑ Four Bedroom'House Gal. ,200 Sq. Ft. AUTO. WASH. MACHINE YES i]" NO ❑ ". 1. / S SITE SUITABLE YES C3. NO ❑ SIZE OF TANK gal. •-/ Q1Q 13C^��c/C iq�d� NITRIFICATION FIELD S / sq'. ft �`` ix j 2- 'EJ / 'L Lj � Ue f DEPTH OF STONE IN' LINES:' I2'`� : /v� ^. ' I WATER'SUPPLY: Individual' ; ❑ •Public � ` IMPROVEMENTS PERMIT BY INSTALLED BY CERTIFICATE OF COMPLETION By �� Dated (8/16/73) *Construction must .c y with all_ o+7tl e�-rr applicable State and local. LOT AREA f w Y i j• .. 7 YJ�