P246 Hwy 64EDAVIE 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 ?;'' w: Vit' }t "<��" DATE s - y PERMITO
N. 246
LOCATION
S.R. NO.
SUBDIVISION NAME 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 ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD g (I sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual,- Public ❑
IMPROVEMENTS PERMIT BYi
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
80
L .. Ft
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900 Gal. 900 Sq. Ft.
1000 Gal. 1200 Sq. Ft.
CERTIFICATE OF COMPLETION :?-//- % V
gy VN- a..TQ _,- Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
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LOT AREA
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