155 Creekwood Drive Lot 62q.. 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 ....Cl1f 'C n- Si'.'C .r hn DATE jj..)p;7.S7- PERMIT
ri
LOCATION N9
S.R. NO.
SUBDIVISION NAME y,;yQ ��5"U s 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 4010 gal.
NITRIFICATION FIELD sq. ft..'
DEPTH OF STONE IN LINES: �4
WAXER SUPPLYr Individual, .;':Public ❑
IMPROVEMENTS PERMIT BY-
House Trailer 800 Gal
Two Bedroom House 800 Gal
Three Bedroom House 900 Gal
Four Bedroom House 1000 Gal
INSTALLED BY:L..P M041AI
778
400 Sq. Ft.
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
tiJ.t3'c1'C}L t.,�-t- V•C�.