P1306 Jack Booe RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Imfovedents Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR I -5 .- r� g i 1 i S DATE ' / �] PERMIT
LOCATION Ir d t� i _ r -� ► r -v :, - _ f j r; +'`� � 1306
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Etj MOBILE HOME ❑ BUSINESS ❑
17ry
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual N1 Public ❑
IMPROVEMENTS PERMIT BY `%I -it
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must c
LOT AREA
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 L.4. O -Y -L.:
r� Date [, i 7 ) %
with all other applicable State and local regulations
�z 1z. t 3. ca
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certify that on I surveyed the property shown on this plat;
that the property lines and location of all structures rr: .accurately shown'ficTeon, that no structure located on this property
encroaches on any adjacent street or property, and that no structure.,on adjacent property encroaches on the premises
xurveyed,"
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LOT NO. ----IAAP OF
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PLAT BOOK PAGE --,I I COUNTY, N. C.
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