P1421 Bethel Church Rdl
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorptlon Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTORDATE PERMIT
LOCATION i��'� r 6� � i �" t ��.� ; `- � �._.. (.,.�;, - 1 f
i
N° 1421
tib, .-4 ,< �� r �, .►i. Z` • S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE P MOBILE HOME ❑ BUSINESS ❑
�t12 House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES Lr1" NO ❑�•%
SITE SUITABLE ct YES NO ❑ / `G �r. �!.
SIZE OF TANK a1.lj�y J'-� �•�
NITRIFICATION FIELD CIO sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY:. 1 INSTALLED BY
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
1:3,)
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR s)h y\e_s Na m- DATE S 7 PERMIT
LOCATIONc,i he( (' . F�J " S' ►,� s (� u K _ �� +` ? 1421
r,r S.R. N0. 6d�t
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE F MOBILE HOME ❑ BUSINESS L
NO. BEDROOMS 3 NO. BATHROOMS :2�I1
GARBAGE DISPOSAL UNIT YES ❑ NO Q'
AUTO. DISHWASHER YES NO ❑
AUTO. WASH. MACHINE YES [a NO ❑
SITE SUITABLE YES Q' NO ❑
SIZE OF TANK q(b gal. q
NITRIFICATION FIELD b sq. ft.
DEPTH OF STONE IN LINES: 9V, le,,e.p —
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
p•1, Q-VJ.
INSTALLED BY XeZ/At
CERTIFICATE OF COMPLETION BY al11&,X;' Date
(8/16/73) *Construction must comply with all o her applicable State and local egxflatlons
LOT AREA 7 ��
OUR-<<
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