P1366 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 - r~ . E_ .. r': t :� _ s,�} DATE PERMIT
N°
LOCATION �- . `, '. �� • 1366
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS 3 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES Er NO ❑
AUTO. DISHWASHER YES [Z' NO ❑
AUTO. WASH. MACHINE YES [7 NO ❑
SITE SUITABLE ,. YES Cf NO ❑
SIZE OF TANKgal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ,'j`" Irod
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
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.
J
INSTALLED BY(*_ %:.. rte; 1 .
Date &-;7
with all other applicable State and local legiflations
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 Ge, e- -7 h r.Scn� C Ire rnPC F�o
„vQ DATE #lj V17 7 PERMIT
LOCATION CQ,,,,, L 2k
N?
1366
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME t3 BUSINESS ❑
House Trailer 800 Gal. 400
Sq. Ft.
NO. BEDROOMS - NO. BATHROOMS
Two Bedroom House 800 Gal. 600
Sq. Ft.
GARBAGE DISPOSAL UNIT YES 0' NO ❑
Three Bedroom House 900 Gal. 900
Sq. Ft.
AUTO. DISHWASHER YES [3' NO ❑
Four Bedroom House 1000 Gal. 1200
Sq. Ft.
AUTO. WASH. MACHINE YES Ef NO ❑
va p,�„r,;,� Ne, 1,o-13 i SS L ek 7 -a) -7� F�
SITE SUITABLEYES OT NO [3SIZE
w6
��� ��''S
OF TANK gal.
�,tr�a,
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: Ie'jef
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
INSTALLED BY
CERTIFICATE OF COMPLETION
p
By
Date
(8/16/73) *Construction must compqy with all
other applicable State and local iegiflations
LOT AREA