P750 Spillman Rd•r� 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 DATE ,,r f� r'% PERMIT
LOCATION �` `� ". r, , . �;. f r - `'s �: r'� 750
S.R. NO.
SUBDIVISION NAME 'f LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME 71 BUSINESS ❑
r
House Trailer 800 Gal. 400
Sq. Ft.
NO. BEDROOMS Vis' NO. BATHROOMS �a.-
Two Bedroom House O; G�al. 600,
SqFt.�
GARBAGE DISPOS—AL UNIT YES El NO ❑-
Three Bedroom House ' -U-Uotal:
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom House 1000 Gal. 1200
Sq. Ft.
AUTO. WASH. MACHINE YES C9 -"'NO ❑
.
ick`°''
i''; :.- ;s;/`x£'�''ae
SITE SUITABLE YES ®'" NO ❑
e.ii1<'S .'
SIZE OF TANK ) gal. lrrj/%edf
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: AIL
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY•' _ 1 t .�,+•_,ir,.
INSTALLED BY�� Si��'�w�p�►�
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must comply with all
LOT AREA .
Date jl--%7_7'
applicable State and local regulations
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