P940 Moses, Naomi• 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, •-!�
> '74,PERMIT
LOCATION i> .r��c
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940
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S. R.
NO.
SUBDIVISION NAME
LOT NO. SECTION OR
BLOCK NO.
HOUSE ❑ MOBILE HOME
BUSINESS
❑
House Trailer
800
Gal. 400
Sq. Ft.
NO. BEDROOMS NO. BATHROOMS
Two Bedroom House.
800
Gala 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 Q
SITE SUITABLE YES ❑
NO ❑
SIZE•OF TANK gal.
NITRIFICATION FIELD
sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑
Public ❑
IMPROVEMENTS PERMIT BY
INSTALLED BY
CERTIFICATE OF COMPLETION- BY�' �'-
(8/16/73) *Construction must comply with all other
LOT AREA
1
Datei'f,
lige le State and local.regulations
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