417 Bailey Chapel RdCOUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor3p�LpnrSewage Disposal System - G.S. Chaptgr 130 -Article 13C)
OWNER OR CONTRACTOR •�; , gra tip• �.-.�, i' E. DATE`'"' /° PERMIT
LOCATION N? 357
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE 4P MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑"�
AUTO. DISHWASHER YES NO ❑
AUTO. WASH. MACHINE YES p 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
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800 Gal. 400 Sq. Ft.
ao 600,,S.q. Ft,
1000 Gal. 1200 Sq. Ft.
INSTALLED BY //i5 S.% to.
CERTIFICATE OF COMPLETION By `.A LU Date AD -3 _V
(8/16/73) *Construction must c mply with all.other applicable State and local regulations
LOT AREA I f RNs .���' :t`� ► c.f,,�rq%r� '�-