1565 Hwy 601S (2)DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption -Sewage DispP sal System - G.S.-Chapter 130-Arti�le�13C)
OWNER OR CONTRACTOR /a j,;' .` DATE 9 PERMIT
LOCATION t 0 ✓n +.; ter y`' T411 1 e-:-
SUBDIVISION NAME LOT NO.
HOUSE MOBILE'HOME BUSINESS ❑
NO. BE ROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO [B
AUTO. DISHWASHER'., YES ❑ No 211-1,
AUTO. WASH. MACHINE YES 0`�' NO ❑
SITE SUITABLE YES 5 -'NO ❑
SIZE OF TANK " gal.
NITRIFICATION FI_.�LD sq. ft:
DEPTH OF STONE INj�LINES:
WATER SUPPLY: Individual' Public ❑
IMPROVEMENTS PERMIT BY
—ate. alw.
SECTION OR BLOCK No.
House Trailer 80 400 ,$_q, Ft.
Two Bedroom House 800 Gal [_600 q-.,.
4 Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY. Deja; c S-7. en. P. V /27ec.
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must ply with all other applicable State and local reg lations
LOT AREA
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