P45 Dalton RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewag.e) Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR + DATE ! •_ ., ja % "PERMIT
LOCATION �", f` ^ t: ' - t . �a' tl 1 i� r^� II l '(�6r d N? ' 45
9 S. R. NO. f
SUBDIVISION,NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME Q BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK( gal.
NITRIFICATION FIELD '': sq. ft.
DEPTH OF STONE IN LINES: ?
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY=t,
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.
INSTALLED BYE-�'-'�
CERTIFICATE OF COMPLETION By �l�.£,✓,�o�
' Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
t �
' {1