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P25 Bernice Hendrix
DAVIE 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 5 <?,,n C. C: (, �' ✓,' "j DATE % .�- �' j "/ PERMIT LOCATION r f , 6z, L. ,; ..._t t�, {, � S.R. N0. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME BUSINESS ❑ House Trailer �8.00.�Gal 400 Sq. Ft. N0. BEDROOMS t'� N0. BATHROOMS Two Bedroom House .$00-�a1. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO Cr" Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES (:3 _NO Q'. Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES NO ❑ SITE SUITABLE YES ©"r NO ❑ SIZE OF TANK gal. NITRIFICATION _FIELD= >' sq. ft. DEPTH OF STONE IN LINES:^� WATER SUPPLY: Individual ©� Public ❑ '. "� =- !"''._. IMPROVEMENTS PERMIT BY .: r' _" _, INSTALLED BY E'i.% W CERTIFICATE OF COMPLETION '' _ f %r,,��.� By Date (8/16/73) *Construction must comply Mith all other applicable State and local regulations LOT AREA