113 Rainbow RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chaptfr 130 -Article 13C)
OWNER OR CONTRACTOR ��. �• ;' ? ' '"y' t : �. DATE �� ��' `'" PERMIT
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1\ . ° 304
LOCATION`S r�, :'�..�"�L ,. •
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE I MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS .• _ NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO LI
AUTO. DISHWASHER YES ❑ NO ET
AUTO. WASH. MACHINE YES/ NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY �r �'� .i'�~•^ " r "'✓'''•
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
l
fi
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400 Sq.
Ft.
800
Gal.
600 Sq.
Ft.
Sq..,
Ft.
1000
Gal.
.,9QD
1200 Sq.
F :s
,.INSTALLED BY /;��*,s C' .•�-
(sk_,,.,' Date
with all other applicable State and locar regulations