P1163 Mock Church Rd• 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 i ^`1C r DATE 7-14. 71, PERMIT
LOCATION �� 116 3
S.R. NO.
SUBDIVISION NAME
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME a 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.11�,-
NITRIFICATION FIELDsq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Q� Public ❑
IMPROVEMENTS PERMIT BY C rx _ �~`rV••. ,,)
CERTIFICATE OF COMPLETION I'
BY
(8/16/73) *Construction must comp
LOT AREA,
�h
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.
INSTALLED BY S�'-
- v,�.. - -- —_ Date ♦ — .17
ith all other applicable State and local regulations
cit
D Y
00
cit
D Y