P358 Shoffner RdT
.. - DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank), Ipiprovements .Permit and Certificate of Completion
(Ground Absorption Sewage,Dispo 1 System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR % ,ry:a ✓� -r %� Ty y DATE `� r PERMIT
LOCATION t'} . r L N? 358
S.R. NO. l�aa
t
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK,%, 00 !7 gal. +
NITRIFICAT ON'FIE-D_' sq. ft.
DEPTH OF STONE IWLINES:
WATER SUPPLY: Intividual ,. Public ❑
IMPROVEMENTOA4gT BY
CERTIFICATE -:OF COMPLETION
By_
R (8/16/73) *Construction must
LOT AREA
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House r&0.�. .._g...-
0 4. .
Three Bedroom House 1-22 90Q,$cLFt.f
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED
Date
c&ply with''all other applicable State and local regulations
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