P500 Main 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 ���'` ` ` Jr ' f' DATE % PERMIT
LOCATION r r'f._ ` ! r"� N?
500
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME f❑, BUSINESS
CERTIFICATE OF COMPLETION By ,? / ,. >' ` `�. r.= , �_ Date /
(8/16/73) *Construction must comply with all. -"other r�rapplicable State and local regulations
LOT AREA
House Trailer
800 Gal.
400 Sq. Ft.
N0. BEDROOMS
N0. BATHROOMS
Two Bedroom Housef)0--6a
$�q:�-�-Ft
GARBAGE DISPOSAL UNIT
YES ❑ NO ❑
Three Bedroom House
•°tel-:�
t -90{q:
AUTO. DISHWASHER
YES ❑ NO ❑
Four Bedroom House
1000 Gal.
1200 Sq. Ft.
AUTO. WASH. MACHINE
YES ❑ NO ❑
—
�.
SITE SUITABLE
YES ❑ N0; ❑
.w /t/� ,/ c <�
., %`•
,�.'.. �',..,�
SIZE OF TANK i
gal.
NITRIFICATION FIELD
=' sq. ft.
f//
'' r
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individua
1,�J Publi_c ❑
IMPROVEMENTS PERMIT BY �'� `
- INSTALLED BY
CERTIFICATE OF COMPLETION By ,? / ,. >' ` `�. r.= , �_ Date /
(8/16/73) *Construction must comply with all. -"other r�rapplicable State and local regulations
LOT AREA