P654 Michaels 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 ' _ "'
DATE PERMIT---
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LOCATION 1 ( i �: �, .. I rN? 654
S.R. NO. ll3
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE E4 MOBILE HOME p BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 0, Public ❑
a
IMPROVEMENTS PERMIT BYQ ir._;
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 $q. Ft.
Three Bedroom House e--500 �G_al`. 0900 Sq. Ft.,
Four Bedroom House ��00 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION�,�
By
(8/16/73) *Construction must comply with.all oth 1
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p licable State and local regulations
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