P753 Center StDAVIE 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 �G. w (' ;, ..F,,�c. pct,-t-�, �. DATE /(-1 - 7-;r.5 PERMIT ry
LOCATION ,,fin t+ f e. e ;,, r - `T Lf, S""T n. C <,;:n r r `»� c t C'1- - N� ( 5 3
�. 4 N
�:, t. Zr, S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
NO. BEDROOMS
LE HOME ® BUSINESS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NO.
BATHROOMS
YES
❑
NO
YES
❑
NO
YES
❑
NO
YES
❑
NO
_ gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public 21
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
A 6ax.A0t,-..
800 Gal. 400 Sq. Ft.
800, al, 600 S�Ft,,,�
900_ Gal%Q,,�,,qS ,t.
1000 Gal.es 1200 Sq. Ft.
4 r R.
It Xkk
o0.a •`C a !� . '�, a A`9 3 91 a
enJ � R t r uSk
900 i ,4 ig-
INSTALLED BY lieu/�e�
CERTIFICATE OF COMPLETION B � m�� —
Y- - Date/=2 w '7S
(8/16/73) *Construction must lomply with all other applicable State and local regulations
LOT AREA
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owe I:re_
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