177 Sourwood Ln.-
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTORX."r"�s,:�Y z l�j+';r �i �+rt DATE w- �`}�-- PERMIT
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231
LOCATIO
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE) MOBILE HOME p BUSINESS ❑
NO. BEDROOMS ► NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO Lam^~
AUTO. DISHWASHER YES �NO ❑
AUTO."WASH. MACHINE YES D NO ❑
SITE SUITABLE YES NO ❑
SIZE.OF TANK gal.
NITRIFICATION FIELD sq. ft.
(DEPTH OF STONE IN LINES: ,..�
WATER SUPPLY: Individual , t��h _Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800 Gal. 400 Sq. Ft.
80 1. 00 . Ft.
0011 900 S . Ft.
1000 Gal. 1200 Sq. Ft.
INSTALLED BY f 5 S.% Go•
CERTIFICATE OF COMPLETION
By CLA n2i A rs Date 9
(8/16/73) *Construction must co ly with all other applicable State and local regulations
LOT AREA
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