866 Angell Rd (3)t
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption SewageDisposalSystem /- G.S. Chapter 130 -Article 13C)
OWNER OR -COQ NTRACTOR J i Y(tt yy c7 �1�/f c /Lf a�%°�� ►l P r},j" DATE_J '� PERMITO
189
LOCATION w 4► r. ,}_
�T S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
s
HOUSE [ MOBILE HOME ❑ BUSINESS [
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES jj'-'NO ❑
AUTO. WASH. MACHINE YES G? --LINO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK - gal. �...,.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual-';--P.ublic ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF.COMPLETION
By
(8/16/73) *Construction must com
LOT AREA C 10ea 9e.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
STALLED BY ..3..,
800 Gal.
400
Sq.
Ft.
8a.x�a1.
'00
S .
Ft.
(,900 _Gal.
900
S
Ft
1000 Gal.
1200
Sq.
Ft.
1
Date
with all other applicable State and local regulations