P560 Sheffield Rd• 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 CONTR=TOR DATE PERMIT
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SUBDIVISION NAME
LOT NO.
HOUSE IV MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS _;I_-_ . NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual V Public ❑
IMPROVEMENTS PERMIT BYfr-
SECTION OR BLOCK NO.
560
House Trailer OG• --Sq-. -F.,.
Two Bedroom House 800OGGa1 600 Sq. Ft
Three Bedroom House 900 Gal. Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
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INSTALLED BY
5, , F4- RNA, I I,d
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
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