P151 Hwy 801DAVIE COUNTY HEALTHfDEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal ystem G.S. Chapter 130_-A ti le -13C)
OWNER OR CONTRACTOR �5 • f.� f'j DATE ""% "PERMIT
No
LOCATION f/ 0/ ""�" 0 r t f +% '
SUBDIVISION NAME
LOT NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS y� NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE :OF TANK Q gal.
NITRIFICATION FIELD .,;,On sq. it.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual^ pPublic ❑
t_..�
IMPROVEMENTS PERMIT BY s /j7,
S. R. NO.
SECTION OR BLOCK NO.
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED
151
1� 41 _.,fit
800 Gal. 600 S Ft
900 Gal. 900 Sq. Ft.
1000 Gal. 1200 Sq. Ft.
U
CERTIFICATE OF COMPLETION gy Date1 _ ?¢ c r , ^Z
(8/16/73) *Construction must comwith all other applicable State and local regulations
LOT AREA %,\d -
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CO-OPERATING WITH
OFFICE OF THE NORTH CAROLINA STATE BOARD OF HEALTH
DISTRICT HEALTH DIRECTOR -
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REPLY TO UNDERSIGNED