1160 Hwy 801N (2)w - DAVIE COUNTY HEA1 Tli DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Di posal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR i1.0"f,, %�,,; i�'"t't°' DATE PERMIT
LOCATION ::.daL# ," + / !2' aka rs ,r j !+"�'Gt 11 .," . ncx` ♦�
SUBDIVISION NAME LOT NO.
HOUSE ®" MOBIL:
NO. BEDROOMS 3
BUSINESS
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 �'gC., �`1 sq.
DEPTH OF STONE IN LINES: f rz
WATER SUPPLY: Individual) Public
IMPROVEMENTS PERMIT BY �I '►+,•/�i°�'d,''-
CERTIFICATE OF
By ---j
(8/16/73) *Construction must c
LOT AREA r''
ft.
FE -1
S. R. NO.
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
30
800 Gal. 400 Sq. Ft.
800 Gal 6QL5a. Ft.
X. X0„0 ,.
1000 Gal.' 1200 Sq. Ft.
INSTALLED BYf,S{�-':..
�' Date i —
with all other applicable State and local regulaiions
•� •-.....__.. __J toe
f
R