484, 490, or 510 Gun Club Rd (3)DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Artiirle 13C)
OWNER OR CONTRACTOR,'; rr {�' .- % �; ; r ; ,,;, DAT F� ���r?/�f ;? t) PERMIT
0
LOCATION ! �/ _ 1 i� E' .i �, •
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE 0 MOBILE HOME E3 BUSINESSIf 11.
❑
NO. BEDROOMS 9� NO. BATHROOMS
.GARBAGE DISPOSAL UNIT YES ❑ NO �~
AUTO. DISHWASHER YES ❑ NO Q"
AUTO. WASH. MACHINE YES CI} ---'NO ❑
SITE SUITABLE YES ER- NO ❑
SIZE OF TANK gal.
NITRIFICATION FIEU6 s 4Z6
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual .� Public ❑
r+ IRPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION B
Y
(8/16/73) *Construction must o Fill
LOT AREA ,f. F? �� S • 1..
�r
726
House Trailer
Two Bedroom House
------ - "-
a
L80r0=Gafi
-
400 Sq. Ft.
600 Sq. Ft.
Three Bedroom House
900 Gal.
D�S
Four Bedroom House
1000 Gal.
1200 Sq. Ft.
INSTALLED BY
:h other app b
Date
le State and.loca reg lations
I
r