4083 Hwy 801NDAVIE 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 r4 V, c�0 _ "i DATE - �- 7 PERMIT
_ NO
LOCATION
C- ' S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [ET MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS 1+ NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK fO'ra gal.
NITRIFICATION FIELD ` sq. ft.
DEPTH OF STONE IN LINES: i a It
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
W
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 4Q0 G„�j
Four Bedroom House 1000G 11 00 Sq. Ft
•0
INSTALLED BY �c ra.., L
CERTIFICATE OF COMPLETION y Cy � Date C(!
(8/16/73) *Construction must c mply with all other applicable State and local regulations
LOT AREA