345 Griffith RdDAVIE COUNTY HEALTH DEPARTMENT
T (Septic Tank) Lnprovements'Permit and, Certificate.of Completion _
i (Ground Absorption S7wage,-Disposal System-...G.S. Chapter 130-Arttele 13C)t /f/
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OWNER OR COXTRACTOR -/3 F r !
F _ _DATE ,' / i PERMIITT p r�
LOCATION } ' ��' �;, [ ',� % >.p lr 487
r S.R. NO.
SUBDIVISION NAME' LOT NO. SECTION OR BLOCK NO.-,
HOUSE p MOBILE HOME p BUSINESS
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ,Y�rt Public ❑
IMPROVEMENTS PERMIT BY / C 4�7' �- �: •"��'�
House Trailer
800
Gal.
400
Sq. Ft.
Two Bedroom House
800
Gal.
600
Sq. Ft.
Three Bedroom House
-900
Gal.
900
Sq. Ft.
Four Bedroom House
1000
Gal.
1200
Sq. Ft.
•�, J? ,
!P
INSTALLED BY
CERTIFICATE OF COMPLETION •.
BY Dat�"�'r�T ,,�._�
(8/16/73) *Construction must
comp
y with'all ther p a le State and loc I z "guullatio3ls
LOT AREA
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