P179 Hwy 801N' DAVIE COUNTY HEALTH DEPARTMENT
• (Septic Tank),. Improvements Permit and . Certificate of Completion
(Ground Absorption'Sewage Disposal System - G.S. Chapter I 0 -Article 13C)
OWNER OR CONTRACTOR J i; f n :? •.�� , f/� �t i�jj/� t :�'j DATE s PERMIT
LOCATION �tili' '`!% +p' '1r �s `%r S' O/Mlr G�IJ 4 ` i'}dt fc.:J N9 179
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 ❑ N0 ❑
SITE SUITABLE YES ❑ NO ❑
SIZE .OF TANK / gal. �✓,
NITRIFICATION FIELD �'�, UO' / sq. ft.
DEPTH OF STONE IN LINES: 10
i
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
Trailer
800 Gal.
400
Sq.
Ft.
VUse
o Bedroom House
800 Gal.
600
Sq.
Ft.
Three Bedroom House
Four Bedroom House
0 Gal.
1000 Gal.
900 Sq. Ft.
200 Sq. Ft.
INSTALLED BY r�—S,a{a
CERTIFICATE OF COMPLETION By Date"
(8/16/73) *Construction must co y with all other applicable State and local regulations
LOT AREA
10
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