P1042DAVIE COUNTY HEALTH DEPARTMENT
s- (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR i DATE 1t„ PERMIT
LOCATION i,,* N?
S. R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
HOME ❑ BUSINESS
1042
CERTIFICATE OF COMPLETION 1u—I g
BY �' Date
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA
House Trailer
800
Gal.
400
Sq.
Ft.
N0. BEDROOMS N0. BATHROOMS
Two Bedroom House
800
Gal.
600
Sq.
Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
Three Bedroom
House
900
Gal.
900
Sq.
Ft.
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom
House
1000
Gal.
1200
Sq.
Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
--' i -
, „ ,
. , ��Zv
SIZE OF TANK q00 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: Ag", Itud a+P-�'
WATER SUPPLY: Individual ('%Public ❑
IMPROVEMENTS PERMIT BY t.
,
INSTALLED BY
Cha.
CERTIFICATE OF COMPLETION 1u—I g
BY �' Date
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA