P429 Hwy 801NM
_ 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 , i ..- i <_ ; " DATE /. -. r /" PERMIT
N? 429
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LOCATION tt, ,, ry ; 1\
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S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 0 BUSINESS ❑
N0. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ®'
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES Q' NO ❑
SITE SUITABLE YES ❑ NO ❑.
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: i
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WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800__Ga1. 400 Sq. Ft.
Two Bedroom House !"$00_Gj. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
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INSTALLED BY F f i It CIO .
CERTIFICATE OF COMPLETION By S�C-'-L MDz,,e b
Date
(8/16/73) *Construction must cdmply with all other applicable State and local regulations
LOT AREA
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