P39 Liberty Church Rdt DAVIE 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 DATEf�!' j�:fi:�ERMI�1
..
�- No 39
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS ra NO. BATHROOMS _�
GARBAGE DISPOSAL UNIT
YES
❑ NO
Cr-""
AUTO. DISHWASHER
YES
❑ _,INTO
AUTO. WASH. MACHINE
YES
N0.-,.
❑
SITE SUITABLE '.
` -�(�
C#'' Nd
:' ❑ '``
SIZE OF TANK1� "
NITRIFICATION FIELD ' 'sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual .Q Public ❑
:.._'.....
IMPROVEMENTS PERMIT BY it, 'r'r= ,' `, %7Y_�•
House Trailer 800 Ga 40n Sq. Ft.
Two Bedroom House
�iq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION
By l Date
(8/16/73) *Construction must comply nith all 4ther applicable St to and local regulations
LOT
AREA
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