P677 Dulin RdDAVIE COUNTY HEALTH DEPARTMENT
j0 (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE`" i ' 7:.y PERMIT
1
LOCATION ca ti :� r j a c+ ,:'.. 6
77
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ® BUSINESS ❑
NO. BEDROOMS 3 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 Wo sq. ft.
DEPTH OF STONE IN LINES: jam.`'
WATER'SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY1 : U.+-c�•>
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BYM
CERTIFICATE OF COMPLETION By � l �V dA Date e. - 3 / . 7yo
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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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 DATE - a (- %SA PERMIT r� r�
LOCATION CdY-h c r l n'� ' �k�,•� - '�iCM� a r c�"`crw j`� a G� 1\ 6
S.R. NO.
SUBDIVISION NAME
LOT NO.
HOUSE 0 MOBILE HOME ® BUSINESS ❑
NO. BEDROOMS 3 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 4W6 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
SECTION OR BLOCK'NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED By
CERTIFICATE OF COMPLETION By R�kK , n11a..._�
Date �
(8/16/73) *Construction must Amply with all other applicable state and local regulations
LOT AREA
VA
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