528 Main Church RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(C^round Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER CONTRACTOR `r"`{, 1�, ; :'; ,t '. DATE I - ►r „ -' iy�PERMIT
119
LOCATION ra ,' i s. 3 r C-�• i r' � t
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE [--1 MOBILE HOME 0 BUSINESS
NO. BEDROOMS NO. BATHROOMS j
GARBAGE DISPOSAL UNIT YES ❑ NO 2;
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES ( NO ❑
SIZE OF TANK " gal.
NITRIFICATION FIELD.°t' sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual k. Public El
IMPROVEMENTS PERMIT BY C ''
House Trailer 800 Gal. 400 Sq.� Ft.
Two Bedroom House 00 Gal, 600
Three Bedroom House 900 Gal. ff Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION✓ By \ Date
(8/16/73) *Construction must "mply with all other applicable State and local regulations
LOT AREA