P269 CooleemeeDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) ImproW.nxs Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ri,, DATE J - PERMIT
LOCATION 269
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
HOME ❑ BUSINESS
NO. BEDROOMS NO. BATHROOMS _L
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO Q
AUTO. WASH. MACHINE YES ® NO ❑
SITE SUITABLE YES f300' NO ❑
SIZE OF TANK';; "._• gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual t9 Public ❑
IMPROVEMENTS PERMIT BY 1,`A
House Trailer 80 Ll. 400 Sq, F_t.
Two Bedroom House 00 Gal~
Three Bedroom House r0Gal. 900 Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY *L) A Ji e 5 T- Co,
CERTIFICATE OF COMPLETION By dp Date 3o 7�
(8/16/73) *Construction must comf3ky with all other applicable State and local regulations
LOT AREA
1 1's),% C_ ;5r, x -! Xt
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