163 Dusty Hill RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewge Disposal System - G.S. Chapter 130 -Article 13C)
0 OWNER OR CONTRACTOR DATE. ;'.. ' ` r'n PERMIT
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'N° 841
LOCATION r.' f t��.' �1 r t '}
---,o 6 �`2< -41 ./ S. R. N 0 .
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SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSEMOBILE HOME LlBUSINESS [INO. BE R OMS
N0. BATHROOMS ^--�-�--
GARBAGE DISPOSAL UNIT YES ❑ NO L
AUTO. DISHWASHER YES ❑ NO @ �`
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES 9 NO ❑
SIZE OF TANK gal.
NITRIFICATION FIE D % Ufa sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY ITi J.
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House f900 Galf. 900 Sq. Ft.
Four Bedroom House 0Gal: 1200 Sq. Ft.
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INSTALLED BY �� _ ��,,� c,��
CERTIFICATE OF COMPLETION By Date 9 '� b
(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA
9