P1228 Hwy 801NDAVIE 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 + % DATE '_.- PERMIT
LOCATION ti- _ N?
SUBDIVISION
LOT NO.
HOUSE ❑ MOBILE HOME ❑ - BUSINESS
NO. BEDROOMS 1 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO Ort
AUTO. DISHWASHER YES 0 -NO ❑
AUTO. WASH. MACHINE YES 0'. NO ❑
SITE SUITABLE YES ❑ Np ❑
SIZE OF TANK gal. .J
NITRIFICATION FIELD! 40"""'; t sq:tt.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual d~ Public ❑
IMPROVEMENTS PERMIT BY % ` .r„ 11
S. R. NO.
SECTION OR BLOCK NO.
House Trailer 800 Gal.
Two Bedroom House 800 Gal.
.;` m Hous; 900 Gal.
.'Three e
_
Four Bedroom House 1000 Gal.
INSTALLED BY
1228
400
Sq.
Ft.
600
Sq.
Ft.
900
Sq.
Ft.
1200
Sq.
Ft. ;
4
I
CERTIFICATE OF COMPLETION B/
y �L Dat
(8/16/73) ' *Construction must comp l, Pith other applicable State and local regulations
LOT AREA