P708DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR ! DATE ' I--. -' , ' PERMIITT r� p
LOCATION ; i 1� (O O
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E3
BUSINESS
❑
House Trailer
800
Gal.
400
Sq.
Ft.
NO..BE ROOMS NO. BATHROOMS
Two Bedroom House
800
Gal.
600
Sq.
Ft.
GARBAGE DISPOSAL UNIT YES
NO ❑
Three Bedroom House
�00_.Gal�
900_^Sq
Ft.!
AUTO. DISHWASHER YES
NO ❑
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
AUTO. WASH. MACHINE YES
NO ❑
SITE SUITABLEYES
SIZE OF TANK U Q _ gal
NITRIFICATION FIELD,lci D40
sq.ft.
DEPTH OF STONE IN LINES:
r
WATER SUPPLY: Individual
Public ❑
4,,/
\
IMPROVEMENTS PERMIT BY
INSTALLED BY ,'lt i9
(
t. r �'
i')A;,i ii �- ;='
• t_.
CERTIFICATE OF COMPLETION
By
Date
(8/16/73) *Construction must
compl with
all other applicable State
and
local
regulations
LOT AREA