P883DAVIE 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 �,,' -, S` DATE , - -7 PERMIT
LOCATION e A. �. ,
N° 883
S. R. 00.
SUBDIVISION.NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Lj MOBILE HOME Q-'. BUSINESS O
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
Gal.
900 Sq.
Ft.
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom House
1000
Gal.
1200 Sq.
Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE -SUITABLE YES [3 NO [3{
SIZE OF TANK ��'�"'"gal.
f
NITRIFICATION FIELDS sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ ' PublicI
❑
/20'
Z;z:�
IMPROVEMENTS PERMIT BY ', �y ' 1 < , ; , .^.
INSTALLED BY
'I
CERTIFICATE OF COMPLETION
BY
(8/16/73). *Construction must c
LOT AREA
L/ 1.�.� �-dti�.. Date `�"�3�20
with all other applicable State and local regulations
J tib j; .l � „• Y.' ; s ` i I r.�
77-7
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