P1158 Cana RdDAVIE COUNTY HEALTH DEPARTMENT
4 (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Dis osal System - G.S. Chaptr 130 -Article 13C)
OWNER OR CONTRACTOR DATE T /' 16 PERMIT
LOCATION &0 CAMcL �A (Ax 1t. + N° 1158
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE p' MOBILE HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO.
DISHWASHER
YES
Q'"
NO
❑
AUTO.
WASH. MACHINE
YES
[
NO
❑
SITE
SUITABLE
YES
['f
NO
❑
SIZE
OF TANK
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Tr Publics ❑
IMPROVEMENTS PERMIT BY
CERTIFI
(8/16/73)
LOT AREA
TE OF COMPLETION
BY—
*Construction must c
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY��'
- n &9- Date ID
ly with all other applicable State and local regulations