193 Call RdDAME COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground. Absorption Sewage Disposal System - G. S. Chapter. 130 -Article 13C),
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#, i i = .ice DATE � •. rf PERMIT
OWNER OR CONTRACTOR �,_,t.;� t -:, .:>
LOCATION 351
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME ❑ BUSINESS
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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 l„ IDIP) sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY• Individual ❑ Public ❑
House Trailer 800 Ga,'-. 400 Sq. Ft.
Two Bedroom House 800 Gal. 60_wµa �F.t
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
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IMPROVEMENTS PERMIT BY �'�!�'..�', d.�-.ry;�INSTALLED
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comp ith al other applica le State and local regulati
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LOT AREA 7 �„ti ,f. s.✓ j
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