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�