P263 Ben Anderson RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt,Ion Sewage Dispb'SaT" Syste1 - G.S. Chapter 130 Article 13C)
OWNER OR CONTRACTOR _ DATE,;;: ire• PERMIT
_., 263
LOCATION
S.R.. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK"NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS y NO. BATHROOMS J
GARBAGE DISPOSAL UNIT YES ❑ NO Ef
AUTO. DISHWASHER YES ❑ NO Q'
AUTO. WASH. MACHINE YES Cl 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
CERTIFICA
(8/16/73)
LOT AREA
r,
TE OF COMPLETION
BY—
*Construction must
6
House Trailer 800 Gal.. 400r„5q_..__Ft.
Two Bedroom House $ff(f Ga
t 1, ('600 Sc�Ft_^�
----
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq_.,Ft.
tA
INSTALLED BY %.,.k W Jk . &_
"_y maAI) Date 7- /g 704
ly with all other applicable State and local regulations
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