P70 Koontz Trailer ParkDAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and. Certificate of Completion
(Ground...Absorption Sewage Disposa. System -'G.S. Chapter 130 -Article 13C)
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OWNER OR CONTRACTOR. +� �.::. a'' is +�`=^° ' r �' F DATE PERMIT
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LOCATION 70�f
_ S.R. NO.
SUBDIVISION NAME *r�. ';: ±�: �s�LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME j45� BUSINESS C
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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: t>�
WATER SUPPLY: Individual,,, 0 Public
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION By s
(8/16/73) *Construction must comp
LOT AREA
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 f
INSTALLED BY
N. f Guest Line-��.p.� Date G°'
with all other applicable State and local regulations
-N
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