P635 Fairfield RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorp.tIo Sewage,Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ti.y.• , •„; r:, r: i.,., /,'�;�.! `” DATE '" " •7 �P RMIT
635
LOCATION t% i n. c 'i .: t,-' +. *.
S.R.
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SUBDIVISION NAME LOT NO. SECTION OR
BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
1 !/,
House Trailer 800
Gal. 400
Sq. Ft.
NO. BEDROOMS .,,:• NO. BATHROOMS -/---`
Two Bedroom House 800
Gal. 600
Sq. Ft.
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GARBAGE DISPOSAL UNIT YES ❑ NO L�I-,_
Three Bedroom House 900
Gal. 900
Sq. Ft.
AUTO. DISHWASHER YES ❑ NO C2
Four Bedroom House 1000
Gal, 1200
Sq. Ft.
AUTO. WASH. MACHINE YES C7- j�¢,.. ❑
SITE SUITABLE YES ❑ NO ❑
'
SIZE: -OF TANK •. if gal.
NITRIFICATION FIELD _ .. , sq. ft.
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DEPTH OF STONE IN LINES: ' r;•. ! =' r` ! Jz,r
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1 r:
WATER SUPPLY: Individual , ❑ Public ❑
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IMPROVEMENTS PERMIT BY I �'. i,. _. ► .4't
INSTALLED BY
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CERTIFICATE OF COMPLETION --�
By
(8/16/73) *Construction must comply with all o
LOT AREA
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�—► Date AL. .
plicable State and local regula ions