P1071DAVIE 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 1\
LOCATION 9 10 71
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer
800 Gal. 400 Sq. Ft.
N0. BEDROOMS .-N NO. BATHROOMS -
Two Bedroom House
800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Rro"
Three Bedroom House
900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO
Four Bedroom House
1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES [9 --,NO ❑
SITE SUITABLE YES Ej-- NO ❑
SIZE OF TANK gal.
ti • , t '-'* T3 c
n xe:
NITRIFICATION FIELD sq. ft.
rt' k:•.,°��u
DEPTH OF STONE IN LINES: , , -
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY L1.1
INSTALLED BY
i « r
CERTIFICATE OF COMPLETION
BY
Date
(8/16/73) *Construction must comp with all
other applicable State and local regulations
LOT AREA
0
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