P1393 Hwy 601N� � T
DAVIE 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 _ ij PERMIT
LOCATION fir, ' - ` ,:v, 1 t t r, < < 'f .W 1\ .
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S.R. NO.
SUBDIVISION NAME
HOUSE
BUSINESS
LOT NO.
NO. BEDROOMS
NO.
BATHROOMS
400
GARBAGE DISPOSAL UNIT
YES
❑
NO
❑
AUTO. DISHWASHER
YES
❑
NO
❑
AUTO. WASH. MACHINE
YES
❑
NO
❑
SITE SUITABLE .r
YES
❑
NO
❑
SIZE OF TANK T? -V
gal.
NITRIFICATION FIELD rt3 sq. ft.
DEPTH OF STONE IN LINES: A
SECTION OR BLOCK NO.
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
WATER SUPPLY: Individual
❑ Public ❑
IMPROVEMENTS PERMIT BY % `_ i ` `1J-,,. 4 0 INSTALLED BY
CERTIFICATE OF COMPLETIONBy ; t_r �1 Date 16— R - 71'
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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