P712DAVIE 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 J PERMIT
LOCATION
N° 712
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME ❑ BUSINESS ❑
t' \
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES M. ` NO ❑
SITE SUITABLE YES ❑ NO^ ❑
SIZE OF TANK tT G� (1 gal.
NITRIFICATION FIELD - ��:jt�~ sq
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY t
House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal: ;900 Sq. Ftp
_-
Four Bedroom House 1000 Gal. &0 S4. -'-Ft.
8o X .3
INSTALLED BY
CERTIFICATE OF COMPLETION
Date
(8/16/73) *Construction must c with all other applicable State and local regulations
LOT AREA