149-151 County Line RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground AbsorptionSewag Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR �F. c�:, in.°� *�," '; DATE ;°s41': : ', '; ?."/ PERMIT
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LOCATION .n ...;.� r., ; Y: s%- ; ;'w:, i 1\ .
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
!' House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal: 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑ - _
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK ga 1.
NITRIFICATION FIELDsq. ft.
DEPTH OF STONE IN LINES:.
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY F rte• "�' r `' Ry /''�" �e j'si
1 .», .�p�C.� ":.►, INSTALLED BY �2, 1 �. �-r rt,� j
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CERTIFICATE OF COMPLETION
Bv—m'A� QM` e Date
(8/16/,73) * onstruction must co' ,ly with all other app icable State and local regulations
LOT AREA r4Y�' _......._M .._-._�_�_ .•..�.____ _.��.w-- .�,_., .
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