P161 Bear Creek Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Abso tion Sew ge Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR 0DATE J�.,,,, i PERMIT
S
l`vi 00 < <t .� _ N , 161
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME ❑ BUSINESS LJNO. B DROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES 0'
AUTO. DISHWASHER YES NO
AUTO. WASH. MACHINE YESof,.. NO ❑
.SITE SUITABLE YES �� ❑
SIZE OF TANK r ->Q gal. V2f�-
NITRIFICATION FIELD 4-Ct5 sq. ft.
DEPTH OF STONE IN LINES: I s
'WATER SUPPLY: IndividualPublic EJ
IMPROVEMENTS PERMIT BY
;CERTIFICATE OF COMPLETION By
(8/16/73) *Construction must com wi
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
STALLED
800 Gal. 400 Sq. Ft.
8 O Gal. 600TSq-
Ft.
900'Gal. 00 Ft.1000 Ga .' 1200. Ft.
Date -"
all other applicable State and local regulati ns
r