P667 Dalton Rd,4r DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal St m G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR II Q % ,. Ge3y�33� DATE .. ;; - �:,'" PERMIT
LOCATION r,"r -t i- 667
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ;y{ 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 "-
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. 1200Sq. Ft.
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INSTALLED BY
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CERTIFICATE OF COMPLETION By < ? ,� ,; ��- Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
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LOT AREA
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