P1236DAVIE 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
LOCATION N? 1236
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑
N0. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO
AUTO. DISHWASHER YES ❑ NO
AUTO. WASH. MACHINE YES M NO ❑
SITE SUITABLE 4Ttrta YES ❑ NO
SIZE OF TANK 'gal. Cx, /Vrl
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
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 �t�,u•��'...7
CERTIFICATE OF COMPLETIONBy } j,�j, Date 1a
(8/16/73) *Construction must c�-o;nf y with all other applicable State and local regulations
LOT AREA
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