P79 Bear Creek Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt*iin Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER, OR CONTRACTOR � 1`' Y Y _i e f �i; E? DATE p "" -- 'PERMIT
N°
LOCAL;ON �'-� �QQG� l'�2 CGSoil
SUBDIVISION NAME LOT NO.
,e
S.R. NO.
SECTION OR BLOCK NO.
HOUSEf� MOBILE
HOME
El
BUSINESS Ll
House Trailer'
NO. B ROOMS
NO.
BATHROOMS
_
Two Bedroom House
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
Three Bedroom House
AUTO. DISHWASHER
YES
❑
NO
❑
Four Bedroom House
AUTO. WASH. MACHINE
YES
❑
NO
❑
SITE SUITABLE .
YES
❑
NO
❑
SIZE OF TANK ~'. gal.
NITRIFICATION FIELD Al DO sq. ft.
DEPTH OF STONE IN LINES: = f -
WATER SUPPLY: Individual/,; M Public ❑
IMPROVEMENTS PERMIT BY 4
�t
Floyd %oda;
INSTALLED BY
79
800 Gal.
400 Sq. Ft.
800 .
900 Gal
1000 Gal.
60 _Sq. Ft.
90.0 Sq. Ft
1200 Sq. Ft.
,a
CERTIFICATE OF COMPLETION By �;�'4t f,,� Date Y-/2-954
(8/16/73) *Construction must c ply with all oth appgrble.State and local regulations
LOT AREA
1 �
1r
V1
"t
i