P20 Rainbow Rd_ DAVIF.., COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Grc;urd Absorption.Sew"age Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR '"'�,' ! . ,' i .�� <.J DATE _" ' ' '�'
-� . " f - PERMIT
LOCATION,-'�{ �- lr ? 2 0
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE 0 MOBILE HOME 0 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 JS gal.
NITRIFICATION FIELD sq. sq. ft.
i/
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ,� Public ❑
IMPROVEMENTS PERMIT BY A
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.
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INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
DAVIE COUNTY HEALTH DEPARTMENT
3 (Septic Tank) Improvements Permit and Certificate of Completion
(Ground ADsorp�ion,Seajage Disposal System - G.S. Chapter 13.0 -Article 13C)
OWNER OR CONTRACTOR `"6- 1 >f ! !� ° DATE PERMIT c
LOCATION t�; -. ..�.�.�^jrc-u_3.,,r N� �+ U
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME tj 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 o% gal.
NITRIFICATION FIELD sq. ft.
r .
DEPTH OF STONE IN LINES: s¢
WATER SUPPLY: Individual }. Public ❑
IMPROVEMENTS PERMIT BY
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
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
1
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