P3 Liberty Church RdDAVIE 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 W4?^y, p jj0WeY C„! DATE PERMIT
LOCATION f`a/:1U 66 /%� O H L.s i f4 &rf i, t %1 /r�;rJ i t'7 nt N0 3
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
.fQU E�� MOBILE HOME jj BUSINESS ❑
6QROOMS Pry NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES g NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD (p Q 0 sq. ft.
DEPTH OF STONE IN LINES: 6_
WATER SUPPLY: Individual bf Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must comp
r t_
LOT AREA-Q'ir71 d / aaV if Q !
1
House Trailer 800 Gal. '4 'Sq. Ft.
Two Bedroom House 8 Gal. 600 Sq. Ft.
Three Bedroom House 90 Gal. 0 Sq. Ft.
Four Bedroom House 000 Ga . 1200 Sq. Ft.
INSTALLED BY J If C -S,
Date 11-2— � 01
with all other applicable State and local regulations