P1235~ 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 PERMIT lr
LOCATION 9
1235
CERTIFICATE OF COMPLETION
By f 1� x - ',-'a .� Date / f
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
S.R.
NO.
SUBDIVISION NAME
LOT
NO. SECTION OR
BLOCK
NO.
HOUSE ❑ MOBILE
HOME
Ll
BUSINESS ❑
House Trailer
800
Gal.
400
Sq.
Ft.
NO. BEDROOMS
NO.
BATHROOMS
Two Bedroom House
800
Gal.
600
Sq.
Ft.
GARBAGE DISPOSAL UNIT
YES
❑
NO ❑'"
Three Bedroom House
900
Gala
900
Sq.
Ft.
AUTO. DISHWASHER
YES
❑
NO ❑ '
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
AUTO. WASH. MACHINE
YES
❑
NO ❑
SITE SUITABLE
YES
❑ '"
NO ❑
SIZE OF TANK ;;
gal.
NITRIFICATION FIELD
sq. ft.
-
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual
❑
Public ❑
IMPROVEMENTS PERMIT BY
i
INSTALLED BY
CERTIFICATE OF COMPLETION
By f 1� x - ',-'a .� Date / f
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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