P584 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 fifc�i,:',t�r; t� ,iarif DATE`"=PERMIT
LOCATION r(J t� �^ !� 4 j lr
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SUBDIVISION NAME
LOT NO. SECTION
OR BLOCK NO.
HOUSE ❑ MOBILE HOME
IN
BUSINESS ❑
House Trailer
800 Gal. 400 Sq.. Ft..
NO. BEDROOMSN0.
BATHROOMS
Two Bedroom House
80p--Gzl. 600 S Ft.
GARBAGE DISPOSAL UNIT YES
❑
NO [W
Three Bedroom House
,:j�00 a r9II S F
AUTO. DISHWASHER YES
❑
NO IR'
Four Bedroom House
1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES
❑
NO ®'
SITE SUITABLE YES
❑
NO ❑
����7'�/F!�'` I
SIZE OF TANK gal.
G
�I
ce
NITRIFICATION FIELD
sq. ft.pp
DEPTH OF STONE IN LINES:
c j ac
WATER SUPPLY: Individual
Q
Public ❑
A tack I'1 ]a
IMPROVEMENTS PERMIT BY
'�'
INSTALLED BY C,
CERTIFICATE OF COMPLETION
B4e
Ir`
Date
(8/16/.73) *Construction mus
comp y with 611
of r,� licable State
and locFre ulati.ons
LOT AREA
/