P1063DAVIE 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 PERMIT
LOCATION lr ? 1063
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
NO. BEDROOMS
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NITRIFICATION FIELD
HOME p BUSINESS
NO. BATHROOMS
YES ❑
YES ❑
YES ❑
YES ❑
gal.
NO ❑
NO ❑
NO ❑
NO ❑
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
CERTIFICATE OF COMPLETION By,ijnilQ~1t-- Date-
(8/16/73)
ate (8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA
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