P683DAVIE COUNTY HEALTH DEPARTMENT
f (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR Y 7' DATE is - 'i ' PERMIT_.
LOCATION N? 683
•
S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME Q BUSINESS ❑
NO. BEDROOMS 14 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES 0 NO ❑ _
SIZE OF TANK ga 1.C'vtJ�ip
NITRIFICATION FIELD ,34) Q sq. ft.
DEPTH OF STONE'IN LINES:
WATER SUPPLY: Individual ❑ Public
IMPROVEMENTS PERMIT BY
r.
House Trailer 8Q,0._.Ga.l,,
Two Bedroom House rr 800 Gal.%J 600 Sq. Ftp;
Three Bedroom House 900 Gal."90b Sq. Ft.
Four Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY-�X� L %�i
CERTIFICATE OF COMPLETION By Date 9 ` -��
(8/16/73) *Construction must com wi 11 other applicable State and local regulations
LOT AREA
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