1366 Yadkin Valley Rd (2)DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorpti n Sewage Disposal System - G.S. Chapter 130 -Article 13C)
r ' 1 s: % Jr, PERMIT
OWNER OR CONTRACTOR DATE
d r ? . s , art . , _
J'
LOCATION
f 1:
SUBDIVISION NAME -- ---•~^
952
S. R. NO. .5 R
LOT NO. .. ,.,.. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ®\\' BUSINESS j❑
NO. BEDROOMS � _ NO.+�EATHROOMS ,/-
GARBAGE DISPOSAL UNIT YES ❑ NO 0.
,AUTO, ' DISHWASHER YES ❑ NO ❑'
AUTO. WASH. MACHINE YES ❑ NO
SITE SUITABLE 4,j -,YES ['' NO ❑
SIZE OF TANK ��a �'ic`� ga 1.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual. Public ❑
IMPROVEMENTS PERMIT BY�
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.
r
•; - /•.`�
_ ..s
r, is „��.
`-!� t,
�`..
INSTALLED BY
r 1,
'.� � ._,•y 1
CERTIFICATE OF COMPLETION By _ yvt r-,_. Date
(8/16/73);., *Construction must Eomp}'with all other applicable State and local regulations
LOT AREA
//0