P502 Bethel Church Rd• 4- T DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate -of Completion
(Ground—,b,.sorption Sewage, Disposal System - G.S. Chapter 130 -Article 13C)
OWNER DATE f o a' PERMIT
N° 502
LOCATION �t:� t '. �. I �. t • L., Y. t.. �, .I k �� i,%.•
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ® MOBILE HOME 0 BUSINESS
NO. BEDROOMS two NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO (�
AUTO. DISHWASHER YES ❑ NO [J'
AUTO. WASH. MACHINE YES & NO ❑
SITE SUITABLE YES Cf NO ❑
SIZE OF TANK 4 � gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: r •'�
WATER SUPPLY: Individual Q Public ❑
IMPROVEMENTS PERMIT BY a:at` '+-k.td "•��
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY C.,
800 Gal. 400 Sq. Ft.
Gal, 6DD--Sq-.-- F t,.
1000 Gal. 1200 Sq. Ft.
il'�!�-.... �r ;�c4-•tea/
a
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comp with all other applicable State and local regulations
LOT AREA
1
L,7