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P809 Sheffield RdDAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal Stem - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR j�. ,'.q ,r r��' y��i15, ,•;:,r; �rJ` DATE Z — 2C -PERMIT No LOCATION SUBDIVISION NAME HOUSE BUSINESS N0. BROOMS N0. BATHROOMS S. R. NO., LOT O.,-- LOT NO. SECTION OR BLOCK NO. GARBAGE DISPOSAL UNIT YES ❑ NO AUTO. DISHWASHER YES ❑ NO AUTO. WASH. MACHINE YES Mo"— 0 ❑ SITE SUITABLE YES [�NO ❑ SIZE OF TANK —""""" gal. NITRIFICATION FIELD 9'J'!> sq. ft. DEPTH OF STONE IN LINES: IQ "/ 2 S`—. WATER SUPPLY: Individual Public ❑ IMPROVEMENTS PERMIT BY CERTIFICATE OF COMPLETION BY— (8/16/73) *Construction must LOT AREA I House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. INSTALLED BY C (!?t I P< eq U tes Date %sem y with all other applicable State and local regulations 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 CONTRACTOR _ f ; �..• ,fes(% . r,/,;%DATE / 7 ).� " PERMIT a LOCATION N° 809 S. R. NO. SUBDIVISION NAME LOT N0. SECTION OR BLOCK N0. HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑ NO. BEDROOMS I --,"NO. BATHROOMS I K GARBAGE DISPOSAL UNIT YES ❑ NO 0 -- AUTO. DISHWASHER YES ❑ NO El ---- AUTO. WASH. MACHINE YES ©-`'NO ❑ SITE SUITABLE YES NO ❑ SIZE OF TANK gal. Sq. NITRIFICATION FIELD - -t-", sq. ft. House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual IMPROVEMENTS PERMIT BY {3' Public ❑ _ J INSTALLED BY:. CERTIFICATE OF COMPLETION By �;�/1--•-,�`-,- -. �.v� �- DateI-) -l(1-9s- (8/16/73) *Construction must compb y with all other applicable State and local regulations LOT AREA i f r