P1130 Sain RdDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorptioewage Dispospil System - G.S. Chaptpr 130 -Article 13C)
NOWNER OR CONTRACTOR ~:r� DATE ��"' /`ci - ` t` PERMIT
LOCATION yr ( ` jay �._` , NO
SUBDIVISION NAME
HOUSE
BUSINESS
11, S. R. NO.
LOT NO. SECTION OR BLOCK NO.
NO. BEDROOMS T NO. BATHROOMS
GARBAGE DISPOSAL'UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO r9 --
AUTO. WASH. MACHINE YES e—NO ❑
SITE SUITABLE YES 0,--e'NO ❑
SIZE OF TANK 22L6 gal.,
NITRIFICATION FIELD }�.� sq. ft.
DEPTH OF STONE IN LINES: /
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY �_'f•/��-4�'+'+'�
1130
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 BYJf.
CERTIFICATE OF COMPLETION By lf , i j ,{, Date
(8/16/73) *Construction must co ly with all other applicable State and local regulations
LOT_ AREA // 3
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