P728 Rainbow Rd (2)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 CONTR;A�CT�OR
,T DATE PERMIT
LOCATION -,,. AO 728
*p. S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE
HOME
❑ BUSINESS ❑
800 Gal.
`�
'4.4
Ft.
900 --Gal.-
lbMal.
House Trailer
N0. BED OOMS
N0.
BATHROOMS
Two Bedroom House
GARBAGE DISPOSAL UNIT
YES
❑ NO ❑
Three Bedroom House
AUTO DISHWASHER
YES
❑ NO ❑
Four Bedroom House
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK_ gal. ff -firj �
NITRIFICATION FIELD %, sq. ft.
DEPTH OF STONE IN LINES: F.� . %" S 417,
WATER SUPPLY: Individual —'Q It Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION BY
(8/16/73) *Construction must co.
LOT AREA
800 Gal.
400 Sq.
Ft.
800 Gal.
60 Sq.
Ft.
900 --Gal.-
lbMal.
00 Pq.
Ft.
12 Sq.
Ft.
; 4.r
INSTALLED BYt'"�" i '. _ r, ,� r ,,. 4"')Ise
Date
with -all other applicable State and local regulations