P407 Hwy 64EDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNE OR CONTRACTOR , t.� �•. �'� C� . z�IM DATE i fi - 14 PERMIT-.:.;
LOCATION ^ �1 i�?� f ` O r �r3 a fi r �' " �� _ i ` i , .tM ! t : TN°
407
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE -HOME ® BUSINESS ❑
NO. BEDROOMS > NO. BATHROOMS,,,���,,,���
GARBAGE DISPOSAL UNIT YES El NO E
AUTO. DISHWASHER YES ❑ NO lJ
AUTO. WASH. MACHINE YES Ff NO ❑
SITE SUITABLE t'" YES Ef NO ❑
SIZE OF TANK 10 dal.
NITRIFICATION FIELD Jt V. sq. ft.
DEPTH OF STONE IN LINES: Ga"
WATER SUPPLY: Individual Public ❑
Sr.R
IMPROVEMENTS PERMIT BYt\..);�'` 1,
1,
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800 Gal. 400 Sq. Ft,
800__Ga_:-600.._.Sq,:,,-,F_t.
.• O ,G, a,),,.�i.Q
1000 Gal. 1200 Sq Ft.
r,
CERTIFICATE OF COMPLETION
By Date
(8/16/73) *Construction must comp y wi all other applicable State and locaons
LOT AREA ; , », ,, JL Z ;
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