P1726 Hickory Hill Lot 3 Block BDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OEOR CONTRACTOR N R �0 J- G L-_ j? hf W CU itis DATE I --;k/,% S PERMIT
LOCATION t G /fid R y h' / L l._. _ y 14 r � L c- N? 1726
S.R. NO.
SUBDIVISION NAME (JKP-`l t I L- LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 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 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
L"
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY pGF.r•�?
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION By Dater�!g
(8/16/73) *Construction must comply with all other applicable State
and
]/local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
_. (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNERt OR CONTRACTOR ' c i �f DATE 1 r /` PERMIT 1 r c
LOCATION (: F 1 t� i t _ ! .. r'_ N? 1 2 6
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p 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:,
r
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1s}►aafvw,Ox
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY ST. dv+
CERTIFICATE OF COMPLETION By
Date alaV178'
�—
.(8/16/73) *Construction must comply with all other applicable
State_ and local regulations
LOT AREA
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