P971DAVIE 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 N9 971
S.R. NO. r'
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME,/Q' BUSINESS ❑
NO. BEDROOMS NO. "BA HR00MS
GARBAGE DISPOSAL.,UNIT YES ❑ NO
AUTO. DISHWASHER YES. ❑ NO []i"
AUTO. WASH. MACHINE YES C}!'NO ❑
SITE SUITABLE YES1 (� ,
i
SIZE l,
OF TANK 90 gal.,.,
NITRIFICATION FIELD 4C6 sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT BY
House Trailer
800 Gal.y
Sq.
Ft..
Two Bedroom House
800 Gal.)
X400
k600
S,q._
Ft,'
Three Bedroom House
900 Gal
900
Sq.
Ft.
Four Bedroom House
1000 Gal.
1200
Sq.
Ft.
INSTALLED BY
CERTIFICATE OF COMPLETION
Byi i ! / y %^-�_ _ Date,
(8/16/73),. *Construction must comply,with all other applicable State and local regulations
LOT AREA r
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4-
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