P101973 Underpass RdHnITH DEP "M EWr—_.__ _
(SEPTIC TANK IMPROVEMENTS PHIRMT AND CERTIf:-ICATE OF COMPLETION
(Ground Absorption Sewage Dispc al System - G.S.Chapt;er.130-Article 13C)
OWNER OR CONTRACTOR DATE 2 — 13 PERMIT NO.
LOCATION 0
/
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME ❑ BUSINESS
NO. BEDROOMSNO. BATHROOMS /
GARBAGE DISPOSAL UNIT YES [� NO l�
AUTO. DISHWASHER YES ,❑ NO ❑
AUTO. WASH. MACHINE YES Lam' NO �l
SITE SUITABLE YES ❑ NO
IZE OF TANK gam- gal.
NITRIFICATION FIELD r J-,�rsq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY Individual Public �]
IMPROVEMENTS PERMIT BY
LOT AREA �2-&-S
NST,