P700 Woodward 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 C,'c,fjel-,f [I,.It''' DATE /0- -7=+r PERMIITT ry
LOCATION - iA. r, ax �,j u -t-1 t,00
{ - = "C r �`� 1� 1� f
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NITRIFICATION FIELD
BUSINESS
NO.
BATHROOMS
YES
❑
NO
YES
❑
NO
YES
❑
NO
YES
❑
NO
gal.
■
■
sq. ft.
House Trailer 800 Gal. 4000 SS Ft.
Two Bedroom House 00 G_ al. ^150 Sg. Ft'
Three Bedroom House 900 Gal. Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY INSTALLED BY Or
CERTIFICATE
r
CERTIFICATE OF COMPLETION
By_
(8/16/73) *Construction must c
LOT AREA
1p -t4-75
I., -Date
th a l other applicable State and local regulations
11
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