P851 Godbey Rd•- , , 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 �,5,�,,�� —1 fj,..� j ++ DATE / - ;'�� �� PERMIT
LOCATION - fi._%-_.1�_•,:_C,- _+C. k cI. w rSY. (TF�f :��^l��- Cri ��.-sJt 7� N9 851
SUBDIVISION NAME
(., ;4-r hr:. r S. R. NO.
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E4 BUSINESS
NO. BEDROOMS a NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK glop_ gal.
NITRIFICATION FIELD 4o Z— sq. ft.
DEPTH OF STONE IN LINES: -- Z9
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800 Gal.
400 Ft.
800 Gal.q=OQS2�:�F('�GAOO
TUBO Gal.
Sq. Ft.
1200 Sq. Ft.
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
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