P1090 Wagner Rd• DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapt�yr 130 -Article
13C)
OWNER OR CONTRACTOR i&zel Shote DATE
PERMIT
LOCATION 4j0. e, P,001 L ', k Q, T 'D r•, v -e—
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1090
` ler, S.R.
NO.
SUBDIVISION NAME LOT NO. SECTION OR
BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800
Gal. 400
Sq. Ft.
NO. BEDROOMS NO. BATHROOMS
Two Bedroom House 800
Gal. 600
Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
Three Bedroom House 900
Gal. 900
Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom House 1000
Gal. 1200
Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK "Inot) gal.
NITRIFICATION FIELD "Jo0o sq. ft.
DEPTH OF STONE IN LINES: 1`(`` (eoclUue, P%9-&,
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
INSTALLED BYQ.""Q_ 'ma4,
CERTIFICATE OF COMPLETION �- 0AQA1
By� 1&,
Date
(8/16/73) *Construction must comply with all other applicable State and
local regulations
LOT AREA
.. �. 11 -.0,11/
DAVIE-��'��
,DtS74R49-T HEALTH DEPAR-1-'MNT
0-1cr Or ..1c `_:T'A'rF DOARD OF' HEALTH CO-OPERATING
DISTRICT HEALTH DIRECTOR
REPLY TO UNDERS113NED
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