P550DAVIE COUNTY, HE-ALTH DEPARTMENT
�R ~
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage
Disposal
System - G.S. Chapter 130 -Article
13C)
OWNER OR CONTRACTOR
DATE
PERMIT
LOCATION "'�
N9
550
✓j��t:.l�" r` ale csc'
S.R.
90.
SUBDIVISION NAME
LOT NO. SECTION OR
BLOCK NO.
HOUSE ❑ MOBILE HOME EO
BUSINESS
❑
House Trailer 800
Gal. 400
Sq. Ft.
NO. BEDROOMS NO. BATHROOMS
Two Bedroom Houser8U0'GaT.L� -EsffO
S F'
GARBAGE DISPOSAL UNIT YES ❑
NO Or
Three Bedroom House 900
Gal. 900
Sq. Ft.
AUTO. DISHWASHER YES ❑
NO Q''
Four Bedroom House 1000
Gal. 1200
Sq. Ft.
AUTO. WASH. MACHINE YES Mr
NO ❑
SITE SUITABLE YES [Er
NO ❑
SIZE OF TANK d'D gal.
4
`
:.,., rl
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY INSTALLED BY��� �► ((R��,
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must 4mply with all other applicable State and local regulations
LOT AREA
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