P1142 Wall StDAVIE 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 4'� DATE PERMIT
LOCATION r'%,r 4 � ��., ! � "r' r (` � � (0 `�/ t 4' {+ t"5�is� ,t ��— L� .t'•r ,;L �}� / '� NO
SUBDIVISION NAME z�,�'„ ' -- / LOT NO. SECTION OR BLOCK N0
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HOUSE Q MOBILE HOME p BUSINESS
NO. BE�ROOMS r--,,, NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES ❑ NO
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK �7,;O 0 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: -/s ,-L- 3{
WATER SUPPLY: Individual �� Pub is ❑
IMPROVEMENTS PERMIT BY
1142
House Trailer
Two Bedroom House
800 Gal. 0 Sc Ft
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0 Gala 0_ Ft
Three Bedroom House
900 Gal. 900 Sq NFt.
Four Bedroom House
1000 Gal. 1200 Sq. Ft.
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CERTIFICATE OF COMPLETION BY Date„
(8/16/73) *Construction must comp ith all other applicable State and locaf regulation
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DAVIE COUNTY HEALTH DEPARTMENT
'(Septic Tank) Improvements Permit and Certificate of Completion
(Ground"Absorption Sewage Disposal System - G.S. Chapter X130 -Article 13C)
OWNER OR CONTRACTOR „(/ �(` Q DATE 'y� '1 •^ ti PERMIT
LOCATION 1�.`� .-� `; {�+ /`% • ;: '.' ,,, • r• ,'''r�t+r, j 1 :�1� ¢ NO
"7• .• .. ..s1 '` s si S.R. NO. /
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SUBDIVISION NAME• !^ =^ i f LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS--�=c--- NO. BATHROOMS �
GARBAGE DISPOSAL UNIT YES ❑ NO L7
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES ❑ NO
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK 7 gal.
NITRIFICATION FIELD /.S"c7sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY �"•� `
CERTIFICATE OF COMPLETION
By
(8/16/73) *Construction must comp
LOT AREA
1142
House Trailer
800 Gal. -/Q- Sa. t�.
Two Bedroom House
-j& 0Gal. 600 Sq. Fti
Three Bedroom House
900 Gal. 900 Sq. Ft.
Four Bedroom House
1000 Gal. 1200 Sq. Ft.
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'-INS-TALLED BY
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Date -9-2(9—
th all other applicable State and local regulations
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