1289 Hwy 64Er
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DAVIE COUNTY -HEAL-'H DEPARTMENT
(Septic Tank) Improvements Permit. and Certificate of Completion
~'(bround Absorption Sewage Disposal System - G.S. Chapter 130-Arti�leo.13C)
OWNER OR CONTRACTOR . ' o e• `n N, ; t 1 >'..„ C'..L DATE 7X PERMIT
LOCATION / F/ TO�_.ry,,� off t r: _ f, r -d� - 121
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME JN BUSINESS ❑
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 t5 �, gal.
NITRIFICATION FIELD t' :`' 'sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800 G 1. 00--Sq,.--F•t,
Two Bedroom House 60Sc�,,,Et�
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
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INSTALLED BY rs th, �+•? Q c Ct
CERTIFICATE OF COMPLETION By .;. ;� ����, C ��% Date "1 ~ q-
(8/16/73) *Construction must coinply with all other applicable State and local regulations
LOT AREAS
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