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P621 Hwy 801S
DAVIE COUNTY. HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorp on Sewage Disposal rSystem G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR " t' to 1' r:' e 0,� �� s. �. i� DATE PERMIT II - ..- LOCATION #o .... Y• ,� .�.- %y c Al sp�� j j; :� eel t.� .'tt , N° 6 21 S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME BUSINESS ❑ NO. BEDROOMS e";- NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO AUTO. DISHWASHER YES ❑ NO AUTO. WASH. MACHINE YES Q'�10. ❑ SITE SUITABLE r. YES © NO ❑ SIZE OF TANK s""!/ gal. NITRIFICATION FIELD+ sq. ft. DEPTH OF STONE IN LINES: „ir' � -I !r, 't,'e WATER SUPPLY: Individual �� 2 Public El/ t IMPROVEMENTS PERMIT BY �ki-eO, 40- � T House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. INSTALLED BY Z).`L,;a CERTIFICATE OF COMPLETION �� Date (8/16/73) (8/16/73) *Construction must omply with all other applicable State and local regulations LOT AREA Ca11ei,4;,4A' /�o /Y'orne-- .arrly d:,ltrr�'aa�S - Gucl' 1 ww