P644 Williams RdDAVIE 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
19 i t r!, t' r:.1.. il/ DATE , �► �,� PERMIT
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LOCATION J L . ,s,� }• A. r � ." e Y Pry � . � , t, Ju b1/ j ) y�'j l� . 644
. r S.R. N0.
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 (r' Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD e
a laa sq. ft. ti It/
DEPTH OF STONE IN LINESs'� IN ► /ewe,
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY `=.w; INSTALLED BY
WL2 04%
CERTIFICATE OF COMPLETION By 1 dq Date
(8/16/73) *Construction must -comp y with all ot herlafpncable State and local regulations
LOT AREA
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