P1089DAVIE COUNTY HEALTH DEPARTMENT
'Wptic� Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR DATE PERMIT
LOCATION ' N?
SUBDIVISION NAME
S. R. NO.
LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME Q BUSINESS Cl
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO
SIZE OF TANK gal. yam. S .'Z q �0
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ���' ituel Mt. ?;PL
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
House Trailer 800 Gal.
Two Bedroom House 800 Gal.
Three Bedroom House 900 Gal.
Four Bedroom House 1000 Gal.
Ant
INSTALLED BY S 7 • r0
(�1
•
400 Sq. Ft.
600 Sq. Ft.
900 Sq. Ft.
1200 Sq. Ft.
CERTIFICATE OF COMPLETION QQ
BY Date
(8/16/73) *Construction must omply with all other applicable State and local regulations
LOT AREA; a
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