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P1162 Hwy 64W
DAVIE COUNTY HEALTH DEPARTMENT '(Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. ChaptV 130 -Article 13C) OWNER OR CONTRACTOR-(,Tt?', Li1r.:� DATE/�"�� PERMIT LOCATION /0'rJ "f A, ri, tJ/-PA-,-uC- S. R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE HOME © BUSINESS ❑ NO. BEDROOMS -^C. NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO 03 AUTO. DISHWASHER YES ❑ NO [r AUTO. WASH. MACHINE YES [!T' NO ❑ SITE SUITABLE YES Tf NO ❑ SIZE OF TANK qgo gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: _19 WATER SUPPLY: Individual B' Public IMPROVEMENTS PERMIT BY House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 1162 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. INSTALLED BY DP,,,', C- S T. Co . CERTIFICATE OF COMPLETION By Date 9-/.3-71. (8/16/73) *Construction must com ly with all other applicable State and local regulations LOT AREA / , 'V"", , rle-" & 1...