P198 Williams Rdr
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 ��=.+2'tt� !^a�t f�i c�.�r DATE- -- 7 PERMIT
LOCATION., G 0 .rk; �• _ _ -. _...__
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME II BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO [P"
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES [5- NO ❑
SITE SUITABLE YES Er" NO ❑
SIZE OF TANK 90-D gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:,'�
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY ,' ,.,, < 1,.,t•-.r`�:ai
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
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QO2,,,5 cam.
900 Gal. 900 Sq. Ft.
1000 Gal.' 1200 Sq, Ft.
INSTALLED BY �� ati,;C.�r,�,
CERTIFICATE OF COMPLETION
By�K' ','"�^, Date 2;=�-,�
(8/16/73). *Construction mustttomply with all other applicable State, and local regulations
LOT AREA
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OFFICE OF THE
DISTRICT HEALTH DIRECTOR
REPLY TO UNDERSIGNED
DAVIE - WILKES YADKIN
DISTRICT HEALTH DEPARTMENT
STATE BOARD OF HEALTH CO-OPERATING
MOCKSVILLE, NORTH CAROLINA 27028
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