P4 Hwy 158DAVIE 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
PERMIT
LOCATION
SUBDIVISION NAME
LOT NO. SECTION OR
BLOCK
NO.
HOUSE MOBILE HOME
BUSINESS ❑
`�]
-�
House Trailer 800
Gal.
400
Sq.
Ft.
NO. BEDROOMS ° NO. BATHROOMS :x-
Two Bedroom House 800
Gal.
600
Sq.
Ft.
GARBAGE DISPOSAL UNIT YES ❑
NO [].
Three Bedroom House 900
Gal.
900
Sq.
Ft.
AUTO. DISHWASHER YES ❑y
NO
Four Bedroom House 1000
Gal.
1200
Sq.
Ft.
AUTO. WASH. MACHINE YES E=(
NO ❑
SITE SUITABLE YES ❑
NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD ';r ✓
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual,
Public ❑
t
IMPROVEMENTS PERMIT BY
INSTALLED BY D A u', S Z
. C �7•
CERTIFICATE OF COMPLETION By Dater—Z
(8/16/73) *Construction must co ly with all other applicable State and local regulations
LOT AREA