P223 Void-41K - DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
'(Ground Absorption Sewage_ Disposal System - G.S. Chapter 130 -Article 13C)
OR CONTRACTOR ,.,r : ,� .�; a ;� � r,.� DATE -- 41— PERMIT
LOC TION i 1.. �/ �, 3 I..eJ, i �otlK
IC ZI r� l �'h� � 223
I r O yy Hr-- S.R. NO.
SUBDIVISION NAME LOT NO. ��. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
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:
WATER SUPPLY: Individual ;.gr Public ❑
IMPROVEMENTS PERMIT BY
CERTI
(8/16/73)
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
STALL D BY
al. t.
900 Gal. -._::900 q.
1000 rai_ �q--:--Ft.
OF COMPLETION
By Date
*Construction must comply with a} 1 other a licable State and local regulations
�.r.a;'eI +. r T
r•
•f DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion '
Ground Absorp-tion Sewage _Disposal System - G.S. Chapter 130 -Article 13C)
,-OWNER OR CONTRACTOR ,-r'r n�, �� �� `� � a. ,� �'` DATE PERMIIT
LOCATION! i .�+ /i 1. % s`) iir� /� C.� i!j �" f`e }/{ t srt 6 $=� it +s" fftva� -O 223
Th' "s .r' c: z-% ftll C V -a Jy iy /, b wfo S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
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: f
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
House Trailer411Q_Sgz-..F,t.
Two Bedroom House �..:8A� Q Caj,)
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four Bedroom House 11000 Gal. 1200 Sq. Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
1V -
-t
I