P1189 Eatons Church Rdr DAAVIE .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 1 q 11W e... DATE i ' %%'"7�= PERMIT
LOCATION f" �: 11' "(" . I . �� t �ll 1+ ' 11 tt .y 1\ 9
• `� . a' \ . � �'.�. � ` f.., t. � � i S •i • 1 t � 1`r l �. � \... � f t �, T i
118 9
ot, r4c..,, r . t 1", 0,1771-5-S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400
Sq. Ft.
NO. BEDROOMS NO. BATHROOMS
Two Bedroom House 800 Gal. 600
Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
Three Bedroom House 900 Gal. 900
Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom House 1000 Gal. 1200
Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
}"� "•�' ck. �"`�'-`r•.
SITE SUITABLE YES ❑ NO ❑"-"'
SIZE OF TANK r a gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Er Publiclz�❑
BY-_;'�..� ���-',.t,..
�`f�-'"'
IMPROVEMENTS PERMIT
INSTALLED BY
CERTIFICATE OF COMPLETION �* ►��Cx h.r�
�+``r
By - Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
i 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 rn!a W4 Ila ee- DATE //-/P-71, PERMIIT
LOCATION too ► ►V 1'' R -i �� C �c� - SQ. 1� I S 1 •1 r,;,12i, I Pi 1, O
N+_.." i1wc�_ c�, t,l ap New Pj, S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS 3
NO.
BATHROOMS
Sq.
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO. DISHWASHER
YES
❑
NO
❑
AUTO. WASH. MACHINE
YES
❑
NO
❑
SITE SUITABLE
YES
❑
NO
❑
SIZE OF TANK 9B
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual QT Publics
IMPROVEMENTS PERMIT BY �� ,T .. ACs
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1189
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY U X,%., SR • Co,
CERTIFICATE OF COMPLETION ByNr.; Q �c C, Date 1 (—I P "7 G
(8/16/73) *Construction must �--omply with all other applicable State and local regulations
LOT AREAx