P258 Milling RdN- 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 R p i, 1. c t..4 �, r..: t,, (zL, d, i 1 DATE 1--i – /,3 -"744 PERMIT
LOCATION '��� ►_� t ;i_, It � s. N � {a't; L'�''-'-
258
S. R. N0.
SUBDIVISION NAME
HOU
NO. BEDROOMS 1,,
LOT NO.
BUSINESS ❑
NO. BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
AUTO. DISHWASHER
YES
❑
NO
AUTO. WASH. MACHINE
YES
❑
NO
SITE SUITABLE
YES
❑
NO
SIZE OF TANK 90-D gal.
NITRIFICATION FIELD 10 afj
sq. ft.
DEPTH OF STONE IN LINES: r„'jr
WATER SUPPLY: Individual, Public ❑
IMPROVEMENTS PERMIT BY
SECTION OR BLOCK NO.
House Trailer 800 Gal. 400,S4--F�t.
Two Bedroom House000 Gad..': 00 Sg..
Three Bedroom House - 0 Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY T2 2,,, e, --a j: o_
CERTIFICATE OF COMPLETION By �� .� r 0 Dates T—�JT
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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1