P94 Deadmon RdDAVIE COUNTY HEATH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(GrouAd;.Absorpption Sewage Disposal System.- G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR %<'; �.y `f ' 3�+ ! i r;Y -� DATE ' '�t- PERMIT
94,
LOCATION +.
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE PROOMS MMOBILE HOME [:1BUSINESS ❑
NO. BE 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 lJ, Public ❑
IMPROVEMENTS PERMIT BY. -
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House - E 900Gal i 900 Sq.`�Ft.
Four Bedroom House 1000 Gal. 1200•Sq. Ft...
INSTALLED BY os , J �..