P1145 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpt on Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR �� �� ! `<1j-1'' DATE PERMIT
LOCATION
SUBDIVISION NAME
i S. R. NO.
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑"'
AUTO. DISHWASHER YES ❑ ,NO
AUTO. WASH. MACHINE YES Lam - NO ❑
SITE SUITABLE YES Q' NO ❑
SIZE OF TANKJ f7,'>[� gals vim}
NITRIFICATION FIELD S''p y sq. ft.
DEPTH OF STONE IN LINES: C �'/
WATER SUPPLY: Individual�•� ❑. Public ❑
IMPROVEMENTS PERMITBY i...%,r✓t'' .�.,
CERTIFICATE OF COMPLETION
BY—/
(8/16/73) *Construction must c
LOT AREA
1145
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600.,Sgw Ft.
Three Bedroom House ! 900 Gall 9- 00 Sg,- Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.'
INSTALLED BY �� i /✓t2.Ci2-� „ . , �:;��
� �. Date ,—
with all other applicable State and local regulations