876 Country LnDAVIE 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 ,� .'. % �' , 'u. �: F DATE w"' ✓'°•' PERMIT
N° 136
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME A BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO 0'
AUTO. DISHWASHER YES ❑ NO [` -'
AUTO. WASH. MACHINE YES 0 NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK p.C." gal.
NITRIFICATION FIELD %V sq. ft.
DEPTH OF STONE IN LINES: /A10—
WATER SUPPLY: Individual )0' Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION By ;
(8/16/73) *Construction mustply with a 1 0
LOT AREA
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 8001. 600 Sq. Ft.
Three Bedroom House _-j L.; 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BYi,4yie. 5..
Dateoe
--
applicable State and local e a iis—