P219 Hwy 801N-- , N
AAW
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Gmund""Ab"sore n'Sewage Disposal S t m - G.S. Chapte, 130- rt'cle 13C)
OWNER OR CONTRACTOR DATE s i3 D'-� PERMIT
LOCATION
TA 17i +cam i 't �i %�� L��/Gc' �j�Q G`°' / �` 9
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
.At
HOUSE ❑ MOBILE HOME BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES C3 NO
NO
AUTO. WASH. MACHINE YES F NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individua
IMPROVEMENTS PERMIT BY JS
ublic ❑
�L.�GC•C�it��
House Trailer �. 400
RPdrnnm NO�1SP 8M _r=i T, 1__ titin c,..
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA ...
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• DAVIE COUNTY HEALTH DEPARTMENT
-- (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Dispgpal SX tem - G.S. Chapter 130-trt4cle 13C)
OWNER .OR CONTRACTOR _'�" ` '' :a�'��f` r �•x.i, 'rr DATE ". ^"' j PERMIT
TO
LOCATION �'�-' '�' .r ?� J)' d •': �"� : 'r"2 AP"
1\ .
SUBDIVISION NAME
LOT NO.
HOUSE ❑ MOBILE HOME ^ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGEDISPOSALUNIT YES ❑ NO L -
AUTO. DISHWASHER YES ❑ NO L1
AUTO. WASH. MACHINE YES Fr' NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual,,,.,. )� Public ❑
IMPROVEMENTS PERMIT BY �;r.f-�i �;C•'f+f.':r)r,.,�w
S. R. NO.
SECTION OR BLOCK NO.
219
House Trailer__ � - X00
Tw ..«6RR...Stl.. ,
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
.j
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable St;ate and local regulations
LOT AREA