P467 Bell Branch RdDAVIE COUNTY& -HEALTH DEPARTMENT
(Septic„Tank) Improvements Permit and Certificate of Completion
(Ground Absor_ n Sew-a,&e Di a_posal System G. S
omOWNER OR CONxRAGTOR�/e4r•r1”:t,D.��A»h.T, E8 3. PeERlM�IET})
LOCATbig ,i.e,.M / N9 4U
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑'. MOBILE HOME BUSINESS ❑
N0. BEDROOMS House Trailer 0 `S F .
- NO. BATHROOMS
^�� Two Bedroom House 00" a 600-Ft1
GARBAGE DISPOSAL `UNIT YES ❑ N0: 'S Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO., DISHWASHER YES ❑. Nd [31,r- Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ .-NO
SITE SUITABLEYES ❑' . NO ❑
SIZE OF TANK v �"'�3`1r!► gal.
NITRIFICATION FIELD s b sq. ft.
1, -_ "
DEPTH.`OF STONE IN LINES
WATER SUPPLY: Individual �Public ❑ r i
`IMPROVEMENTS PERMIT BY INSTALLED BY r a_L_"
th all other apF
_ _Date J
)cal regulations