P801 Salem Church RdDAVIE COUNTY HEALTH DEPARTMENT
-► I (q�pttc,,,,TMk),;Improvements Permit and Certificate of ,completion ....:: <..,,.-
(Ground Absorptign Sewag6,Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE PERMIT
LOCATION '''f G r• 4 vt t I ,� ti t' r:: z r' r«a �f 'f a' "; C+�f 4 ti! �': _3 N�` 801
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE 0 MOBILE HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS' —
GARBAGE DISPOSAL UNIT YES M/ NO ❑
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES Da ---'NO ❑
SITE SUITABLE' YES C]�'
SIZE OF TANK gal.
NITRIFICATION FIELD 200 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
yr. �
House Trailer 800 Gal. 400
Sq. Ft.
Two Bedroom
House 80 0 Gal. 600,Sc.F�t.
Three Bedroom House 4 90,5, [900 Sq Ft,
Four Bedroom
House 1000 Gal. 1200
Sq.'-Vt.
f
/���f
70
J
INSTALLED BY��`~
.
CERTIFICATE OF COMPLETION By r �--L1. Date
(8/16/73) *Construction must Coy with all other applicable State and local regulations