P1577 Hickory Hill Phase 2l+ :' DAVIE COUNTY 'HEALTH DEPARTMENT
i(Septic. Tank) Improvements;; Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System G.S. Chapter 130-Article13C)r .
{� OWNER OR' -•CONTRACTOR - ��' �? j t • DATE
l.,f ; l �,.p.-a i t, r d PERMIT. ry
LOCATION .. 1! d y 1
t .
S.R.' NO. '
SUBDIVISION NAMEA. LOT N0: SECTION OR BLOCKNO..
nuuor, Lj r%ymLjjz numL V zuslNtbb U
NO. :BEDROOMS f NO.- BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑'".
AUTO. DISHWASHER }' YES Q- NO ❑
AUTO. WASH. MACHINE., YES. 0 -NO ❑
SITE- SUITABLE ; YES ❑f NO ❑
SIZE OF TANK' ga 1. - .
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE'IN LINES:
`-WATER SUPPLY: —Individual, 0 Public
:'IMPROVEMENTS~ PERMIT BY
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. 11000 Gal. 1200
Sq. Fit,.
INSTALLED BY_
DAVIE COUNTY HEALTH DEPARTMENT
'(Septic. Tank) Improvements .Permit and Certificate of Completion
(Ground Absorption. Sewage.Disposal System - G. S. Chapter 130-Article 13C)
1 ;OWNER OR'-CONTRACTOR DATE ��; ;�.; PERMIT
I,
LOCATION
°` 1517
S. R.' N0.
SUBDIVISION'NAME i .r{!y'. ;� !l_ ! LOT N0. �' li SECTION- OR BLOCK N0.
HOUSE ❑ MOBILE-HOME BUSINESS ❑ =
House Trailer 800-Gal. 400 Sq. Ft.'
NO. :BEDROOMS', ,. NO.. BATHROOMS Two.Bedroom House 800 Gal. 600 Sq. Ft:
GARBAGE'DI$POSALjIUNIT YES ❑ NO ❑` Three Bedroom•House 900.Gal. -900 Sq. Ft.
-.AUTO. DISHWASHER' YES Q' NO '[3, Four Bedroom House '..1000 Gal. 1200 Sq. Fit".AUTO. WASH.-MACHINE YES.. 0 NO [3 it".
SITE' SUITABLE YES . []f NO ❑'/a`r. `' ( t' J: f fl ', . _f� .
SIZE OF TANK d, ga 1. - ,
NITRIFICATION FIELD sq* ft.
DEPTH OF STONE, IN LINESs
WATER.,,SUPPLY: Individual. ❑ Public ®„
'IMPROVEMENTS PERMIT BY r '.d. ;, f' L •L' 1 c�, INSTALLED ;BY
.CERTIFICATE OF CONPLETI0N
By. Date
..'(8/16/73) *Construction must comply with fall .other applicable State and local regulations
LOT AREA
41,
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