P1218DAVIE 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 �. 1\ 9 1218
S.R. NO. r �i
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME tj BUSINESS ❑
NO. BEDROOMS N0. BATHROOMS House Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House x-800 Gal, 1,600 Sq. Ft..
GARBAGE DISPOSAL UNIT YES ❑ NO (] Three Bedroom House '900 Ga.l.,900 Sq..•Ft.,
AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑ 4
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
+ i
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual 13 Public ❑ n
IMPROVEMENTS PERMIT BY j`, -- INSTALLED BY PL.t w
CERTIFICATE OF COMPLETION
BY Date
(8/16/73) *Construction must compl with all other applicable State and local re ulations
LOT AREA "
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