192 Mortgage Hill WayT DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage_.D,isposal System - G.S. Chapter 130 -Article 13C)
OWNER OR ,qONTRACTOR - v' ` I �' r, %� DATE ' • �-r - -' rI �r PERMITO
240
LOCATION
S.R. NO.
SUBDIVISION NAME
HOUSE
BUSINESS
LOT NO.
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.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
SECTION OR BLOCK NO.
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House $AQ.Sa V -6"00 -
Three Bedroom House J.20.D_.Ga l -.900--Sq-:-Et..-
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
eV
rY
f ±
INSTALLED BYt".puY':'a
CERTIFICATE OF COMPLETION By ' ,� ,% ?•'. , , �t �, Date `~' _, ` �,_" 7
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA ,,,` `'V - f `'' S
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