P1233DAVIE COUNTY HEALTH DEPARTMENT
A (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
. N° 1233
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME E. BUSINESS ❑
NO. BEDROOMS t- NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES ❑f NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK I y r gal.'
NITRIFICATION FIELD /,) sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY w,
i
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.
P
1:
CERTIFICATE OF COMPLETION
By - Date.,'.
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA `-