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P1191 Gladstone RdD.AVIE,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, (_ 1\ r t5 �,) cx DATE PERMIT LOCATION j_ ' t', • ' {t i.�" � r'l (.� �}'� a.�4�.i: � � � %. � 1 f't � L i �-.> 1 f.t c �^.�. k' � • � �f 1 va � � � . r '� •\ �� � �. j^ � • S. R. NO. SUBDIVISION NAME LOT NO. HOUSE [ MOBILE HOME ❑ BUSINESS ❑ NO. BEDROOMS NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO ❑ AUTO. DISHWASHER YES ❑ NO ❑ AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLE YES ❑ NO ❑ Vo SIZE OF TANK / 0 o gal. D.S.T 4,. NITRIFICATION FIELD (o D 0 sq. ft. DEPTH OF STONE IN LINES: 4k "/ 1,V4- Pya-t. WATER SUPPLY: Individual ❑ Public IMPROVEMENTS PERMIT BY fan}E: y'irl,�zt. SECTION OR BLOCK NO. House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 1191 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. INSTALLED BY �ia �, C. 1 i CERTIFICATE OF COMPLETION By S_ -R Date //- 2 V-7 (8/16/73) *Construction must c6knply with all other applicable State and local regulations LOT AREA�h'X1G"'rt;r�