P580 Ben Anderson RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR !r �_ � , �!q s DATE /,- 17 • y �5' PERMIT Q
LOCATIONr. c i"t. r� tF 1�:I� i ..€. 1 ], i NO 500
S. R. NO. /3,21
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
B
NO. BEDROOMS
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO. DISHWASHER
YES
❑
NO
❑
AUTO. WASH. MACHINE
YES
❑
NO
❑
SITE SUITABLE
YES
❑
NO
❑
SIZE OF TANK
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House -,$GO -Ga. 60 -0 -Sq. -Ft.
fit.
Three Bedroom House'' 900 Gal._) (`900 So. Ft%
Four Bedroom House ,'`iO00 Gal. 1ZGU-$Fq. Ft.
f,�j. s , Uc,y a?i
UJ 1N-. c- jcttc- --i d.0 .
TC /. 71-,/- a J 7
IMPROVEMENTS PERMIT BY �.. -iter, t� I INSTALLED BY ! -a
CERTIFICATE OF COMPLETION BY_ 1
(8/16/73) *Construction must comp
LOT AREA q, � � r c $
Date 4�
th all other applicable State and local regulations
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s � i
DAVIE COUNTY l,EALA;H UEPAR'TNIENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
' OWNER. OR CONTRACTOR S t-, j; �'�(�,. DATE i S7
PERMIT
LOCATION�I:�,: �'.•�L� 13 1 -O
MLT
500,
S.R.
NO. 1-3-21
SUBDIVISION NAME LOT NO. SECTION OR
BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
7
House Trailer, 800
Gal, 400 Sq. Ft.
NO. BEDROOMS -� NO. BATHROOMS
Two Bedroom House �iGa_
a_j' 0 •
GARBAGE.DISPOSAL UNIT YES ❑ NO ❑
Three Bedroom House 900 Gala' 00S(
QU00
AUTO. DISHWASHER, YES ❑ NO ❑
Four Bedroom 11ouse
Gal. 1 q. Ft.
'-AUTO. WASH. MACHINE YES ❑ NO ❑
_
����`Jt �' `�
SITE SUITABLE YES ❑ NO ❑
}� i
SIZE OF ' TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
° IMPROVEMENTS PERMIT BY C. -
INSTALLED BY
�i Date 4 ►� "—���
with all other applicable State and local regulations
C1D
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