748 Baileys Chapel Rd (2)� ,..� .o.. �.
DAVIE COUNTY HEALTt.H DEPARTMENT
` 4 (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE ; - _a� %- ; 0 PERMIT
_ No 125
ii
LOCATION T A.C 7�Ca�r � �# tS F; �� _ •
SUBDIVISION NAME
LOT NO.
HOUSE ❑ MOBILE HOME R9 BUSINESS ❑
NO. BEDROOMS _ NO. BATHROOMS /
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO i;,
AUTO. WASH. MACHINE YES 19 NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK c/ gal.
NITRIFICATION FIELD -7 <? Z)
sq. ft.
DEPTH OF STONE IN LINES: / r,, r.+y
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
S. R. NO.
SECTION OR BLOCK NO.
House Trailer 8 400 Sq. Ft.
Two Bedroom House800 G 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
it ► ._ :, f rA C
INSTALLED BY Ito III E�X,
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must c ply with all other applicable State and local regulations
LOT AREA