P256 Howell RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNLK OR CONTRACTOR DATE { ! ' s PERMIT
_.O 256
LOCATION
. , .
�';t S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 0 BUSINESS
NO. BEDROOMS 11 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD`"' QUO sq. ft.
DEPTH OF STONE IN LINES: f'r" /0
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
900 Gal. 900 Sq. Ft.
1000 Gal. 1200 Sq. Ft.
tiJ 3 I— IN ;rx.4y;.>.A...,
INSTALLED BY I Ci" -SL_ W
CERTIFICATE OF COMPLETION Bv—
Date 7-
(8/16/73) *Construction must Amply with all other applicable State and local regulations
LOT AREA
FVESKM
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