P1146DAVIE 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 r t' _ • •', ' " i't.' 1 C_ -_DATE %{ - :,. PER
., MITNo
LOCATION ,>:: �. y ... ✓ �y.. `7 r 1146
-- -- � S.R. N0.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE Q MOBILE HOME p BUSINESS
NO. BEDROOMS 4': NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ ,,NO LI
AUTO. DISHWASHER YES ❑ .-NO ❑
AUTO. WASH. MACHINE YES ❑ tiNO ❑
SITE SUITABLE YES NO ❑
SIZE OF TANK gal.
NITRIFICATION.FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual .;r(' *,Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION. By
(8/16/73) *Construction must
LOT. AREA
5 / S
House Trailer
_1800-6a•l ' 4kJQa..S,,q__.Ft.,'
Two Bedroom House ..,,x.,800
Gal J -'600
S,g .- Ft; "
Three Bedroom House
900 Gal. 900
Sq. Ft.
Four Bedroom House
1000 Gal. 1200
Sq. Ft.
/ �
J
-INSTALLED BY �i 1 t C C, -S 1- p
Non`Ab Date %— /—?I
ly with all other applicable State and local regulations
F
f r
f
4»w.
F