P538 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 *. DATE :r PERMIT
LOCATIONS . 538
_ S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOU
LE HOME ® BUSINESS
NO. BEDROOMS 12
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
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Q Public ❑
IMPROVEMENTS PERMIT BY;
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 8_00_,.Ga_l. 600, Sq._ Ft.
Three Bedroom House ,-- 0. Gtr 9-O 0, Ft.;
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
F l
`t e , ; y. btu C. ,... }6C t iz - 1A V: \
INSTALLED BY
CERTIFICATE OF COMPLETION Date
(8/16/73)
(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA
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