P1000 Mock 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�-
DATE -,;_:- PERMIT
LOCATION i .' t ` ' " � ;;_ ' ; � � .r v' r , k 9�t'
"N°
+ " � .. ; a .
1000
`'S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
1� - ; ,,.
HOUSE M] MOBILE HOMEBUSINESS
[3"1
House Trailer 800 Gal. 400
Sq. Ft.
NO. BE60OMS , NO. BATHROOMS
Two Bedroom House $OO Gal. _600
Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ "
Three Bedroom House x,900 G;'l '900
_Sq. FtL
AUTO. DISHWASHER YES ❑ - NO ❑
Four Bedroom House 1000 Gal. 1200
-Sq."Ft.
AUTO. WASH. MACHINE YES NO ❑
`'
SITE. SUITABLE YES ❑ NO ❑
.� ;; _:. r •: 1 i :' t'� AC.�
c
SIZE OF TANK 11,. ,,,_-, gal.
}
NITRIFICATION FIELD `;:> sq. ft.
DEPTH OF STONE IN LINES: -.- �7 0
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BYt ''.` ` l_.
INSTALLED BY
CERTIFICATE OF COMPLETION By
(8/16/73) *Construction must comp
^• 4
LOT AREA "`` r
with all other applic
Date •,r....-, ,
le State and local regulations