P1172 CooleemeeDAVIE 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 .� 41 ��, r. , ��r• DATE/Y' • Jlr PERMIT
LOCATION . cl+ �T%tio r: Sj. C' ,<<! ,r''' t�CL N? 1172 2
fiS.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Er MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE C YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual lJ Public ❑
IMPROVEMENTS PERMIT BY'; -f
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY 1Q,cx Z,S :T• Cc, ,
CERTIFICATE OF COMPLETION e
By Date i o` t 5 `D e
(8/16/73) *Construction must com ly with all other applicable State and local regulations
LOT AREA
DAVIE 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 /o PERMIT
LOCATION �ti}:1��t�� i I„ „.;,�y )4 :. t r , ^,,, NO
{-(--, C )+A C 100 E j S. S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Q MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS :4 NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES Q` NO ❑
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE�jj YES ❑ NO ❑
SIZE OF TANK l 6 gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: ,_.ter
WATER SUPPLY: Individual 53 Public ❑
IMPROVEMENTS PERMIT BY `��•_ )1r"�?,.t..�s1
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
1171
800
Gal.
400
Sq.
Ft.
800
Gal.
600
Sq.
Ft.
900
Gal.
900
Sq.
Ft.
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY cx,.u� �' C—
CERTIFICATE OF COMPLETION By
�� Date
(8/16/73) *Construction must comp y with all other applicable State and local regulations
LOT AREA -w 0 0 X i �t ' i # c L
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