P508 Madison RdDAVIE 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 C'rr �-, aw,C 6cip� DATE PERMIT
LOCATION tti N� 508
6' r� ti. ca a S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 -Gal. 600 Sq. --Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House �. 900 Gal,�`i 900 Sq. Ft.;)
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK _ gal.
jUW
NITRIFICATION FIELD Q sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY 0
INSTALLED BY �,` • c. �' i
CERTIFICATE OF COMPLETION BY fe) -e N a,-4-3 Date owl. - X.
(8/16/73) *Construction must comp y with all other applicable State and local regulations
LOT AREA
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