P1222DAVIE 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 N? 1222
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE
BUSINESS
NO. BEDROOMS
NO.
BATHROOMS
GARBAGE DISPOSAL UNIT
YES
❑
NO
D
AUTO.
DISHWASHER
YES
❑
NO
❑
AUTO.
WASH. MACHINE
YES
❑
NO
❑
SITE
SUITABLE
YES
❑
NO
❑
SIZE
OF TANK
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By_
(8/16/73) *Construction must
LOT AREA
e?
House Trailer 800 Gal.
Two Bedroom House y_800 Gal.
Three Bedroom House '-900 _Gal,ti
Four Bedroom House 1000 Gal.
INSTALLED BYE,:..
400
Sq.
Ft.
Sq.
Ft.
1.600
,9,00_S
q.
Ft.'
1200
Sq.
Ft.
t'
r
yv\Qn� Date 3 77
ly with all other applicable State and local regulations