P58 Hwy 158r DAVIE COUNTY HEAtttj DEPARTMENT
'(Septic Tank) Improvements Permit' and Certificate of Completion
(Ground -+Absorption Sewage Disposal System .- G.�.* Chapter 130-Artic1e_�L3C•)`
OWNER.OR CONTRACTOR J15 DATE
PERMIT
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LOCATION` >
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11 (J
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S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
;HOUSE MOBILE HOME BUSINESS ❑
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/
NO. BEDROOMS r N0: BATHROOMS /
House Trailer
1. 400
Sq. Ft.
Two Bedroom House
11"a 600
Sq. Ft.
';GARBAGE DISPOSAL UNIT YES ❑ NO E
Three'Bedroom-House
900 Gal. 900
Sq. Ft.
'AUTO. DISHWASHER YES NO Ell`
Four Bedroom House,-
1000 Ga'l. '1200
Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
'
,
!}NC
SITE SUITABLE YES, NO ❑
SIZE OF TANK
NITRIFICATION FIELD "' sq. ft.
DEPTH OF STONE IN LINES: '
WATER SUPPLY: Individual ❑ ❑
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IMPROVEMENTS PERMIT BY
—INSTALLED BY
CERTIFICATE OF..COMPLETION K-�•
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By
Date
(8/16/73) *Construction must corVly with all other applicable State and local regulations
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