P215 Elmore RdDAVIE COUNTY HEALTH DEPARTMENT
,. „;�•,,(.Septip:jank) hnprovements. Permit and Certificate.,Qf_Co�npletion ,.,, .,,....
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(Grrau> &- Absorption:°Sewage Disposal System G. S Chapter 13b -Article 43�'
.A,OWNER OR CONTRACTOR • �? ,s g:' �'" DATE r PERMIT
r ti N
LOCATION
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE, ❑ MOBILE
HOME
;
BUSINESS ❑
House Trailer
NO. BEDROOMS
NO.
BATHROOMS
Two Bedroom House
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
Three Bedroom House
AUTO. DISHWASHER
YES
❑
NO
Four Bedroom House
AUTO. WASH. ,MACHINE
YES
❑
NO
❑
t- ! `Rt>'' ry
SITE SUITABLE
YES
❑
NO
❑ ,
SIZE _OF TANK La40 gal.,4g
NITRIFICATION FIELD'? sq. ft.
DEPTH OF STONE_ IN LINES:
WATER SUPPLY: Individual�.Public ❑
IMPROVEMENTS PERMIT BY �1 •,r-�.. / / . ti--•.•��.5=
800 Gal.
800 Gal.
900 Gal.
1000 Gal.
215
400 Sq. Ft.
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
INSTALLED BY 07-0 ��� LAJ�Y
CERTIFICATE OF :COMPLETION By Date 3 "';?
(8/16/73) *Construction must corWly with all other applicable State and local regulations
LOT AREA.
w
.» X10
NO
ID -
CL
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