P107 Gladstone 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 DATE PERMIT
IN 107
LOCATION �,
ie �;I� ;�rit tiro 4
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME ❑ BUSINESS I
NO. BEDROOMS: T NO. BATHROOMS
GARBAGE'DISPOSAL,UNIT .YES. ❑ NO M
AUTO. DISHWASHER YES ❑ NO [
AUTO. WASH. MACHINE YES Z NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE; OF TANK,} gal.
NITRIFICATION FIELD `meq. ft.
DEPTH Of, STONE IN LINES:
WATER SUPPLY: Individua ;RI -Public ❑ ,
IMPROVEMENTS PERMIT BY i
House Trailer
800 Gal. 400 S Ft.
Two Bedroom House
Three Bedroom House
90:.`
AER�q
fr
Four Bedroom House
1000 Ga ' 6"'S'q':e'
-.-
that +1 �",:1��, 1=�*i
t� rs 11 rtic�
INSTALLED BY
CERTIFICATE OF COMPLETION ByDate � 2"
.�� - 5
(8/16/73) f*Coonlst_ruction must compt§ with all other applicable State and local regulations
LOT AREA
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