P29 No Creek RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage
Disposal
System -
G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTORDATE
m ,�• : `;..�, 5. i :' ' r
Ft.
% �- PERMIT
M
/ .
600
., 29
LOCATION
r
i , c'.:
V` ► *= �' .!.)' 3 :
900
Sq.
Ft.
S.R. NO.
SUBDIVISION NAME
Gal.
LOT NO.
SECTION OR BLOCK NO.
HOUSE CI MOBILE HOME
BUSINESS
❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ N0: ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK r 6 0' gal.
NITRIFICATION FIELD rte. 3, sq. ft.
DEPTH OF STONE IN LINES:.
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY,, 1.'wr, «:',;;,,;.•
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 •; AA -Q
CERTIFICATE OF COMPLETION --`
By l � r-��'�'L'` Date/—&--
(8/16/73)
ate%'&-(8/16/73) *Construction must coy, with all other applicable State and local regulations
LOT AREA
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