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P1196 Hwy 64W
t DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption SewageDisposalSystem - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR CO,,iC�`�r� ri��� y DATE <t t' j ti} 7(.� PERMIT LOCATION .tt -v 5°ttLT 1`1-"01 :.1,7- N? 1196 S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. 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 D0 gal. NITRIFICATION FIELD DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ❑ Public IMPROVEMENTS PERMIT BY `,++-c 'i''V°.�J iI CERTIFICATE OF COMPLETION By (8/16/73) *Construction must comp LOT AREA 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. 4,. lid " / 4os e, INSTALLED BY ��c.� Date 11-3 0 ' �P with all other applica a State and local regulations n,. 0 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 0',Y►e, DATE PERMIT LOCATION Uq ko - 0,%T to 1196 S. R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME BUSINESS House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES ❑ NO ❑. �eo`�k- $',sStic� SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK 2© Qf K� it gal. COrv��er„ V r1c) NITRIFICATION FIELD .. J Z.- ` q. ft. l `CLO. Rtiss`�� DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ❑ Public X IMPROVEMENTS PERMIT BY CERTIFICATE OF COMPLETION By (8/16/73) *Construction must comp LOT AREA INSTALLED BY 7, W , Z(S e -S Date with all other applicable State and local regulations Ph �Tj C� D p /,(-? X/8'" keel fyi �n, ppb raj.-f'%^K.