P643 Ridge Rda„ 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 CONTRACTOR 7� �, �,�1 Y DATE PERMIT
LOCATION , .. . �
-` n A * 1� 9 643
R
! 1 n, r- ,C'. �- S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME K BUSINESS
NO. BEDROOMS NO. BATHROOMS _ I
GARBAGE DISPOSAL UNIT YES ❑ NO Lam"
AUTO. DISHWASHER YES ❑ NO (J�-•''
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES S'� NO ❑
SIZE OF TANK gala
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: lsl. level
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY 421". ,
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY 12aj; e e, -•T• Co.'
CERTIFICATE OF COMPLETION
BY Date D -
(8/16/73) *Construction must mply with all other applicable State and locar regulations
LOT AREA «�
or, -•�
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