P114 Baileys Chapel RdDAVIE 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 �4 ! .c1 rii t�`�1 h, DATE -. - PERMIT
r N° 114
LOCATIONS a. t �- +e f i
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME Jif BUSINESS ❑
NO. BEDROOMS r NO. BATHROOMS /
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES JW NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 'Zrt) gal.
NITRIFICATION FIELD cro sq. ft.
DEPTH OF STONE IN LINES J
WATER SUPPLY: Individual Public ,a ❑
IMPROVEMENTS PERMIT BY '�' a••
CERTIFICATE OF COMPLETION �"
BYE }
(8/16/73) *Construction must con
LOT AREA
House Trailer 800 400 S . Ft.
Two Bedroom House 00 Gal OO Sq: Ft.
Three Bedroom House G.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY 1,2!2z,
„ .
�•-.�.Ga.,.E.d•�ttr..� Date 9"
with all other applicable State and local regulations