P254 Hwy 64EDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit,. and: Certificate of Completion
(GrounduAbsorption Sewage Disposal System - G.S. Chapter 130 Ar iIcle 13C)
OWNER OR CONTRACTOR „-i �� DATE (- / , ,: PERMIT
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LOCATION ; - ^; ` , ;. . '! , w t �-, • T;
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE
HOME ❑
BUSINESS
❑
�.
House Trailer
800 Gal.
400 Sq. Ft.
N0. BEDROOMS
N0. BATHROOMS
Two Bedroom House
800..Ga1.t
600 -Sq. Ft,
GARBAGE DISPOSAL UNIT
YES ❑
NO ❑
Three Bedroom House
_200Qg1.:=c
AUTO. DISHWASHER
YES ❑�
NO ❑
Four Bedroom House
1000 Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE
YES ❑
NO 0""'T
.r� i+
� -A z— �" Y"� � t `� {� ""'';,
SITE SUITABLE
YES [3
NO ❑
�;%
SIZE OF TANK ;'s'�-'
gal.
NITRIFICATION FIELD
'fK:"-x
sq. ft.
e
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
Public ❑
�/*
IMPROVEMENTS PERMIT BY
�' ,-:' ;.:..-•-,�x.';a•-..,t... �%
INSTALLED BY �/Ci
� �.7". •
CERTIFICATE OF COMPLETION
Y%iCL�nt�6t
By
Date
(8/16/73) *Construction must Anply with
all other applicable State and local
regulations
LOT AREA.
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