P368 Duke Whittaker Rd< DAVIE 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 F. C 1 = , y- .- DATE PERMIT
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LOCATION ' "i" ,r;11 /"/,0 �; +�: 5 u� , ' %% jirr r 1\ 3O
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#.'1 r , c.. n t C� t.' i > , r, "? , .. v c S. R. NO. f ;1 L3
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
LE
BUSINESS
NO. BEDROOMS ",7,
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑ NO
AUTO. DISHWASHER DISHWASHER
YES
❑ NO
Q -'
AUTO. WASH. MACHINE
YES
C}',NO
❑
SITE SUITABLE
YES
®'� NO
❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: !e
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House (00Da3900 S�q. Ft,,j
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY(�C/
CERTIFICATE OF COMPLETION By / Date
(8/16/73) *Construction must comp l ith all// other applicable State and local regulations
LOT AREA G+% Z-)
/co c