P877 Broadway RdDAVIE COUNTY HEALTH DEPARTMENTf
9(oadtvaq.
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article
13C)
OWNER OR CONTRACTOR :.. ,, , c` i ,,, -.� . ,�, , DATE 7� . ;<t-, . ~r �
PERMIT
LOCATION PIP,
U
877
t ! S.R.
NO.
SUBDIVISION NAME LOT NO. SECTION OR
BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
House Trailer 800
Gal. 400
Sq. Ft.
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 ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 121 gala
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:'�
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY ``', 4: ; ,- , �, :
INSTALLED BY
CERTIFICATE OF COMPLETION ByC V,yNow.Ci-G _ 2s -,7 1
Date
(8/16/73) *Construction must c ply with all other applicable State and local regulations
LOT AREA
I