P1055 Milling RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
(OWNEV OR CONTRACTOR DATE PERMIT
L�--O--CA✓✓TION N9 1055
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
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 1 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:/�-
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY L,? rrt,-t - Co ,
CERTIFICATE OF COMPLETION BY Date �-
(8/16/73) *Construction must omply with all other applicable StFte and local regulations
LOT AREA
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