P1963 Milling RdW
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 `�,,'�' nYo ill. <Pw DATE {� 21 PERMIT
LOCATION�"11; ,1 y '1► c ra r 1963
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Ea�-' MOBILE HOME
❑
BUSINESS ❑
House Trailer
800
Gal.
400
Sq. Ft.
N0. BEDROOMS N0.
BATHROOMS
Two Bedroom House
800
Gal.
600
Sq. Ft.
GARBAGE DISPOSAL UNIT YES
❑
NO ❑
Three Bedroom House
900
Gal.
900
Sq. Ft.
AUTO. DISHWASHER YES
❑
NO ❑
Four Bedroom House
1000
Gal.
1200
Sq. Ft.
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
❑
Public ❑
�;.�
i'` '�
_.
t�
'_
IMPROVEMENTS PERMIT BY
,�1
INSTALLED BY
CERTIFICATE OF COMPLETION
��) i . -c t j,-�
By..
Date
(8/16/73) *Construction must
comply with all 6ther
applicable State
and
local
regulations
LOT AREA
•.. x rr r �P ;,�t..c�:° 1". �y',:�
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