P565 Farmington RdDAVIE 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 ; t, �E �, , rte�, `P r DATE j- /L: - Y.5'PERMIT
LOCATION c7 tr :;1 r` i iI "i1J.,�► ci t d� *f i , "�"r l J \C ''X 1 N 565
VSr%L xfii 4}`. S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 0 BUSINESS ❑
NO. BEDROOMS - ;1,
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO. DISHWASHER
YES
❑
NO
❑
AUTO. WASH. MACHINE
YES
❑
NO
❑
SITE SUITABLE
YES
❑
NO
❑
SIZE OF TANK
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer�Gal.600
Ft.
Two Bedroom House . Ft.
Three BedroomHouse. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY k.%'
CERTIFICATE OF COMPLETION By YY� Date a a
(8/16/73) *Construction must co ly with all other applicable State and local regulations
LOT AREA ��, f� C RC 5