P669 Dalton RdDAVIE COUNTYHEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR 1 i w DATE '`' - " 'a-" PERMIT
LOCATION .t - ;, i ; : - 1\ 669
�?,• _:a x '� �- S.R. N0. /�.r,.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
BUSINESS ❑
NO. BATHROOMS
YES
❑
NO
❑
YES
❑
NO
❑
YES
❑
NO
❑
YES
❑
NO
❑
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House r--500--GaT': -' 500 Sq. Ft:"--,
Three Bedroom House'"-900-'GaI.%00" Sq':"'FC.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY ! 1 INSTALLED BYi
CERTIFICATE OF COMPLETION
BY
(8/16/73) *Construction must omply lith other appl
LOT AREA l�O
Date
e State and local regulations
C�' I., r; r . -1 V,, ,.`