P1214DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
R OR CONTRACTOR DATE r' PERMIT c�
ATION N9. 1214
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
f
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE ?,pgO YES ❑ NO ❑
SIZE OF TANK-: gal.' *
NITRIFICATION FIELD �., sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
House Trailer 800 Gal.
Two Bedroom House 800 Gal.
Three Bedroom House 900 Gal.
Four Bedroom House 1000 Gal.
INSTALLED BY
400
Sq.
Ft.
600
Sq.
Ft.
900
Sq.
Ft.
1200
Sq.
Ft.
Date" -),4-- .- f �)
with all other applicable State and local regulations