P814 Fairfield Rdr �
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 ; �_� _ -; ••;PERMIT
LOCATION_.r.. ND
814
S.R. NO. </,•�
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME '[3' BUSINESS ❑
NO. BEDROOMS NO. `BATHROOMS
GARBAGE;,DISP.OSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑%
AUTO. WASH. MACHINE YES ❑ NO
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK ga1�A,T-J,p
NI IFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: R1101
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED
`CERTIFICATE OF COMPLETION' By Date
(8/16/73) *Construction must c y with all other applicable State and local regulatirfri"s
LOT AREA
r