P210 Redland RdAA
DAVIE COUNTY HEALTH DEPARTMENT
;- (Septic ;Tank)g Improvements Permit and Certificate of Completion ,..,.
(Ground'Absorption Sewage D,posal Sys em - G.S. Chapter 130 -Article 13C)
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OWNER OR CONTRACTOR t•� ! �°? c-++0, DATE :% w '�..^ PERMI
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LOCATION 4'
210
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S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO..
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HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS Z NO. .BATHROOMS
House Trailer
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Two Bedroom House 0 a
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 C :NO ❑
SITE SUITABLE YES [ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq—ft.,
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑ 1�'
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IMPROVEMENTS PERMIT BY ,#
INSTALLED BY
CERTIFICATE OF COMPLETION --
BY Date
(8/16/73). *Construction must co ly with all other applicable State and local regulations
LOT' AREA
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