P5 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorp on Sewage Disposal S sem - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ,: f_lrc DATE �[� «' '�• PERMIT
LOCATIONt��1lu �iD l ela o C,.'�c� �G �t
5
SUBDIVI
LOT NO.
HOUSE MOBILE HOME U BUSINESS
NO. BEDROOMS NO. BATHROOMS /
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES gNO ❑
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE ��..yy YES [3 NO ❑
SIZE OF TANK 4 400
D gal.
NITRIFICATION FIELD 1p,:%40 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual "public ❑
IMPROVEMENTS PERMIT BY y+,, /b+,.'.G�4"��,.' mss•
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
STALLED
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
CERTIFICATE OF COMPLETION
By � � �l,L� Date�/g--
(8/16/73) *Construction must compl with all other applicable State and local regulations
LOT AREA ID D` f C'
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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disp9sal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR .*,...._.kDATE
PERMIT -
LOCATION
�; Y, `:�3 f Cff .+ 1 Gd �.: Lr t c✓ f El tr V {ll
S.R. NO. `„f3 /
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE J:Q MOBILE HOME p BUSINESS
NO. BEDROOMS _ NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES 1' NO ❑
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD co -'5 /P 0 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY'�t , i o ,�- .t'= �'✓,
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq..Ft.
1000
Gal.
1200
Sq.
Ft.
CERTIFICATE OF COMPLETION
BY �� � �'�' -�'�'1�, Date
(8/16/73) *Construction must comp ,with all other applicable State and local regale ions
LOT AREA � {? r -1, 41* 457 I
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